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1.
Front Pediatr ; 10: 869893, 2022.
Article in English | MEDLINE | ID: covidwho-1809486

ABSTRACT

Background: Since The Italian Medicines Agency (AIFA) has recommended the COVID-19 vaccine Comirnaty in children aged 5-11, the immunization campaign faced vaccine hesitancy in parents. Social media are emerging as leading information source that could play a significant role to counteract vaccine hesitancy, influencing parents' opinions and perceptions. Our aim was to evaluate the coverage of the COVID-19 vaccine Comirnaty in a cohort of children aged 5-11 whose families have been counseled to use Social Media to counteract vaccine hesitancy. Methods: All parents of children aged 5-11 in a primary care setting were instructed by their pediatrician to get accurate information about the COVID-19 vaccine from a Facebook page. Active calls to vaccinate children were also scheduled through messaging services Pediatotem and Whatsapp. Vaccination rates of children in the study were assessed with an electronic database and compared to both regional and national child vaccination rates. Results: Coverage of 277 children aged 5-11 was analyzed from 16 December 2021 to 31 January 2022. A total of 62.4% (173/277) of enrolled children received the 1st dose of COVID-19 vaccine Comirnaty and 39.7% (110/277) the 2nd dose. Coverage rates were higher compared both to the regional population (1st dose: 48.8%, 2nd dose: 24.6%; p = 0.001) and national population (1st dose: 32.1%, 2nd dose: 13.8%; p < 0.001). Conclusion: Increasing vaccine confidence using Social Media interventions have a positive impact on vaccination acceptance of parents.

2.
Medical Hypothesis, Discovery, and Innovation in Ophthalmology ; 11(1):11-18, 2022.
Article in English | EMBASE | ID: covidwho-1798537

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19. Methods: We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: “eye,” “ophthalmologic,” “ocular,” “vision,” “conjunctivitis,” “severe acute respiratory syndrome coronavirus 2,” “SARS-CoV-2,” “corona,” “2019-nCoV,” “COVID19,” and “COVID.” The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review. Results: A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis. Conclusions: Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.

3.
Annals of Emergency Medicine ; 78(4):S44, 2021.
Article in English | EMBASE | ID: covidwho-1748273

ABSTRACT

Study Objectives: Though a growing number of EDs receive telehealth services to care for pediatric patients, little is known about the recent usage of pediatric telehealth across all US EDs. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory (NEDI)-USA survey characterized all US EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services (n=469), we selected a random sample (n=130) for a second, in-depth survey on pediatric emergency care and pediatric telehealth usage (2019 Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 Pediatric Telehealth Survey (n=107), for a total of 237 EDs in the final 2019 Pediatric Telehealth Survey sample. Descriptive statistics are presented as frequencies and proportions. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. Among the 107 EDs first surveyed in 2017, 89 (83%) responded to the 2019 survey. Among these 89 EDs, 63 (71%) reported receiving receiving pediatric telehealth in both 2017 and 2019, 1 (1%) in 2019 only, and 13 (15%) in 2017 only. Among the 130 EDs only surveyed in 2019, 104 (80%) responded and 85 (82%) confirmed their receipt of pediatric telehealth. Overall, 149 responding EDs confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a board-certified pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. 60% reported using pediatric telehealth services less than once per month, and 20% reported using services every 3-4 weeks, although 96% reported that these services were available 24 hours per day, 7 days per week. Most received pediatric telehealth from either another hospital in their hospital system (39%) or a hospital in a different hospital system (38%). EDs most frequently used pediatric telehealth to assist with diagnosis (73%) and treatment (78%) of pediatric conditions, and with placement and transfer coordination (91%). Almost all (93%) reported using pediatric telehealth to evaluate children (1-17.9 years) and 62% for infants (<1 year). Among the 63 EDs that confirmed pediatric telehealth receipt in both 2017 and 2019, there was an increase in EDs using pediatric telehealth for diagnosis of pediatric conditions (+7%), placement and transfer coordination (+11%), and staff education (+13%). There was also an increase in EDs using pediatric telehealth to evaluate both children (+12%) and infants (+11%). Conclusion: Most EDs receiving pediatric telehealth in 2019 had no board-certified PEM physician or pediatrician available, suggesting that telehealth services are being used to supplement access to pediatric expertise. Most EDs used pediatric telehealth services infrequently. The most common usage of pediatric telehealth was for placement and transfer coordination. We encourage future research on the effect of the COVID-19 pandemic on national usage of ED pediatric telehealth.

4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S340-S341, 2021.
Article in English | EMBASE | ID: covidwho-1746519

ABSTRACT

Background. COVID-19 pandemic caused by SARS-CoV-2 resulted in a global health crisis in 2020. Quarantining, wearing masks and physical distancing- key infection prevention strategies implemented to stop the spread of COVID-19, also led to dramatic decreases in rates of common respiratory viral infection seen in young children. Due to lack of school and daycare exposure, we evaluated a larger than usual number of patients with periodic fevers without any known infectious contacts. Based on this observation, we conducted an analysis of all suspected cases of periodic fevers seen at our institution during the COVID-19 lockdown compared to prior seasons. Methods. The clinical charts were queried for all patients presenting to any Lurie Children's Hospital outpatient specialty clinic or laboratory with ICD diagnosis code of MO4.1 and MO4.8 (all recurrent and periodic fever syndromes) from June 1, 2020 through September 30, 2020, and compared to similar months the previous 2 years (2018 and 2019). Each patient chart was reviewed by the lead investigator to verify all new diagnoses of PFAPA. The number of new patients with PFAPA diagnosis were tallied and analyzed. Statistical comparisons were made using Kruskal-Wallis tests for monthly distributions in different years. Results. We noted a significant increase in patients with new PFAPA diagnosis between June through August 2020 compared to similar months in 2018 and 2019 (Figure1). Experienced pediatric infectious disease physicians and rheumatologists diagnosed majority of the cases. During these months, a monthly median (IQR) of 13 (11.5, 14.5) patients were diagnosed among different Lurie specialty clinics, which is more than 2.5 folds increase in new PFAPA patients from the previous two years which were about 5 (3.5, 6) (Figure 2). Conclusion. We observed a significant increase in PFAPA patients referred to our institution soon after introduction of public health measures to slow spread of COVID-19. Given that most children were not in daycare, schools, or camps, we suspect that parents and pediatricians were able to recognize patterns of periodic fevers in children much quicker than preceding years, when fevers would typically be attributed to an infectious process.

5.
Journal of Emergency Medicine, Trauma and Acute Care ; 2022(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1737249

ABSTRACT

Background: Effective communication among physicians and nurses in in-patient settings is associated with better patient care1, increased teamwork, and job satisfaction2, however, no literature has addressed the concern of the gap in perception of communication between physicians and nurses.3 this study aims to explore the perceptions of physicians and nurses toward proper communication and collaboration before and after an intervention. The study period encompassed before and during the COVID-19 pandemic. Methods: A cross-sectional pilot survey was administered in September-November 2015 in pediatrics in-patient wards at Hamad Medical Corporation (Doha, Qatar) followed by a post-intervention program survey in November-December 2020. The interventions included establishing a multidisciplinary unit-based council involving physicians and nurses, and a communication skills course for physicians. The questionnaire included details of demographics, perceptions towards proper communication, and collaboration in daily clinical practice. Questions used a 3-point Likert scale. Result: 124 responses (66% physician/44% nurses) were obtained in 2015 and 83 responses (51% physician/49% nurses) in 2020. The physicians' reported perceptions improved for nearly all survey questions, often in a statistically significant way, but it was not the case for their enjoyment of collaboration which was reduced by 10% points (p = 0.01) (Table 1). The enjoyment of collaborating with the other professions declined for the physicians (p = 0.01) whereas it improved for the nurses, but it was not statistically significant (p = 0.06). For the nurses, their perception improved across all items, but less often in a statistically significant manner. In general, nurses had higher levels of satisfaction regarding communication and team collaboration (Figure 1). Conclusions: Our study showed that physicians and nurses' perceptions improved post-interventions. Nurses seemed to be more affected by the interventions. The biggest effect was in decision sharing as both had almost a similar improvement. Promoting communication and collaboration in a complex clinical environment is paramount. Interventions such as multidisciplinary rounds and adapting structured communication tools improve organizational culture.

6.
Molecular Genetics and Metabolism ; 132:S359, 2021.
Article in English | EMBASE | ID: covidwho-1735113

ABSTRACT

Introduction: On 1st October 2019, a consented pilot study to screennewborns for Duchenne muscular dystrophy was initiated in NYS. Thepilot study is a collaboration between Parent Project MuscularDystrophy, New York State Newborn Screening (NYS NBS) program,Northwell Health Hospitals, New York-Presbyterian Hospitals, NBSTranslational Research Network (NBSTRN), American College ofMedical Genetics (ACMG), and funders. Institutional Review Board(IRB) approved the study. However, the COVID-19 pandemic led todiscussions regarding ending the pilot study unless alternativeprotocols could be established.Methods: Prior to the pandemic, patient enrollment was conductedon-site. Study coordinators at hospitals consented families in-personusing e-consents built in REDCap™ (a secure web application forbuilding and managing online surveys and databases) on hospitalapproved tablets. The specimens were then shipped to the NBSprogram where they were tested for the NBS panel and procedureswere instituted to cross-check consent forms. Duchenne results werereleased on the standard NBS report. Any baby with a borderline resulthad to have a repeat NBS specimen collected and submitted to theprogram. Any baby with a positive result would be referred and seenby a clinical genetics team, and an additional blood specimen wascollected and submitted for second-tier molecular testing. Babies withpositive molecular test results would be followed by a specialist, andfamilies would be offered carrier testing and given information aboutDuchenne and the opportunity to participate in clinical trialsDuring the pandemic, fully remote patient screening, recruitment, andreporting processeswere implemented. The remote study effortswerecomplicated by staff retention issues, technical and software/Wi-Figlitches, computer illiteracy requiring extensive instructions (a subsetof patients), lack of email access. Paper consent mailing requiredsubstantial resources.Significant resources were required at the NBS program as well.Follow-up required research staff coordinate the redraw of thesamples with the parents and pediatrician’s office and referrals weremade by telehealth or in-person visits. For molecular testing, a buccalswab sample collection kit was mailed to the families opting fortelehealth.Conclusion: Despite the challenges, development of remote studyprocedures enabled successful continuation of the pilot during thepandemic. These newprotocols could be applicable in the absence of apandemic as a complementary method to in-person recruitmentprocess and follow up, which would facilitate enrollment of patientswho would otherwise be missed. Implementation of this hybridapproach leads to optimization of patient enrollment, which couldapply to a broad spectrum of future studies and clinical trials.

7.
Journal of Investigative Medicine ; 70(2):480-481, 2022.
Article in English | EMBASE | ID: covidwho-1709227

ABSTRACT

Case Report Anorexia Nervosa is a mental health disorder with significant morbidity and mortality. Acute food refusal is one of the indications for admission. We present a patient who went to extreme lengths to restrict food intake, requiring intensive care sedation and ventilation to enable enteral feedings. 12 year old male, was admitted with symptoms of anorexia nervosa and BMI of 12.0, (<1%ile) with baseline BMI of 16 (25%ile), K of 3.3 and glucose of 54. He was treated with supervised eating on an inpatient pediatric floor with no need for enteral feeding. Psychiatry consultation confirmed the diagnosis of anorexia nervosa and recommended the addition of Olanzapine to his Sertraline. He was discharged pending placement in an eating disorder center after 21 days of hospitalization with discharge BMI of 14. He was followed as an outpatient by his pediatrician, dietician and counselor but unfortunately, he required readmission 11 days after discharge due to acute food refusal, with BMI that had dropped to 13.1. Patient was readmitted and started on nasogastric (NG) feeds but he became severely agitated, pulling NG out multiple times and continued to lose weight with BMI dropping to 12. Sedation was attempted to facilitate maintenance of NG feedings, with Benadryl, Haldol and Ativan, but was ineffective at levels deemed safe without compromising his airway and breathing. Due to severe malnourishment and unsuccessful NG feeds he was transferred to PICU for sedation, endotracheal intubation and continuous nasoduodenal (ND) tube feedings on two separate occasions while inpatient. He was able to wean from the ventilator but once awake he found ways to manipulate delivery of his calories, even finding scissors and cutting the ND tube. The patient ultimately agreed to eat in order to avoid replacement of the feeding tube. He was finally transferred to an eating disorder facility, with a BMI of 13.9 and persistent anorexia thinking with restriction of eating anything but pizza. Patient completed three months of an inpatient program and had significant improvement in BMI to 19.3 (70%ile). He was subsequently discharged for continued outpatient follow-up and since discharge from the eating disorder center, his BMI has shown steady improvement in outpatient follow-up. He shows no signs of food refusal and is doing well with Family Based Therapy. This case highlights several unique characteristics in management of eating disorder patients. The age and being male along with extreme food refusal and resistance to enteral feeding that led to the requirement of deep sedation are quite unusual and not well described in the medical literature. The severity of his illness was a significant barrier to inpatient placement. In addition, despite a nationwide attempt to find an inpatient facility for him, which took several weeks, we identified shortages in eating disorder beds that have been exacerbated by the COVID-19 pandemic.

8.
Journal of Investigative Medicine ; 70(2):595-596, 2022.
Article in English | EMBASE | ID: covidwho-1705497

ABSTRACT

Case Report A 7-year-old healthy boy with a history of COVID-19 infection 10 months ago and history of recent tick exposure presented with 6 days of intermittent fevers up to 40C and right sided axillary lymphadenopathy. During his first emergency room visit, labs were reportedly normal and the patient was discharged home. The next day, his fevers continued and he developed generalized abdominal pain and emesis. At his pediatrician's office, labs were significant for a leukocytosis. He then developed conjunctivitis and was admitted to an outside hospital for worsening fever and emesis. There, labs were significant for a C reactive protein (CRP) of 7.9 mg/dL and erythrocyte sedimentation rate (ESR) of 51 mm/hr. Urinalysis had no pyuria. Tick titers were also obtained. He was transferred to our facility for additional treatment with concern for Kawasaki disease due persistent fevers, cervical lymphadenopathy, lip redness, and a generalized rash. Upon arrival to our facility, he was well-appearing. Besides an intermittent rash with fevers, review of systems was otherwise negative. Our initial differential diagnosis included Kawasaki Disease, Multisystem inflammatory syndrome due to COVID-19 (MIS-C), tick-borne illness, or a systemic viral infection such as adenovirus. Examination was significant for conjunctivitis and small mobile right axillary adenopathy. Laboratory studies were significant for leukocytosis (15,000/mm3), elevated CRP (10.1 mg/dL), and elevated ESR (85 mm/hr). A respiratory viral panel and COVID-19 serology were both negative. D-dimer was elevated at 295 ng/mL. The rest of his labs including chemistries were normal. An echocardiogram was obtained, which was normal, and infectious disease was consulted. He was started on empiric doxycycline due to the history of tick exposure. He was observed overnight and developed no further fevers. However, due to his continued abnormal laboratory studies and in the setting of an otherwise negative workup for other diagnoses, we treated him for KD. He was started on high dose aspirin and given 2 g/kg of IVIG. 24 hours after completing IVIG, he had a fever of 38C, so he was observed an additional 24 hours. He was discharged home to complete a 7-day course of doxycycline and on low dose aspirin with plans to follow up with cardiology clinic. Our case makes many illustrative points for the clinician. Our patient had four of the five findings involving bilateral conjunctivitis, oral changes (strawberry tongue/injected pharynx/ fissured lips), peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. However, many of these symptoms were absent upon arrival to our facility and his fevers had subsided. There were also other factors such as his age that were unusual for typical KD along with his recent tick exposure and past COVID-19 infection that made his diagnosis more difficult to determine. This case highlights the importance of remebering that common conditions may have unusual presentations.

9.
Critical Care Medicine ; 50(1 SUPPL):586, 2022.
Article in English | EMBASE | ID: covidwho-1691815

ABSTRACT

INTRODUCTION: Pulmonary arteriovenous malformations (PAVM) are typically associated with hereditary hemorrhagic telangiectasia. Isolated PAVM are uncommon and usually present between the 4th-6th decades of life;they are rarely seen in children and infrequently necessitate ICU admission. DESCRIPTION: A healthy 3-year-old boy presented to his pediatrician with a 3 day history of fever and rhinorrhea. He was hypoxic (SpO2=85%), so was placed on oxygen and transferred to an outside ED where he was found to have (non-COVID) coronavirus. He was admitted for supportive care but clinically deteriorated over the next 24 hours requiring intubation, ventilatory support with 100% FiO2, and inhaled nitric oxide. Despite these interventions he remained hypoxic. Echocardiogram demonstrated a structurally normal heart. Computed tomography angiogram showed multiple large peripheral PAVM in the left lower and upper lobes and no differentiation between arterial and venous phases indicating pulmonary shunting. He was transferred to our quaternary ICU for intervention. He underwent embolization of ~70% of his PAVM (limited due to contrast load). He initially improved, but 2 days post-intervention he declined with worsening hypoxia likely secondary to pulmonary vascular remodeling following intervention and residual shunt burden within the left lung. Given his instability, as well as an oxygenation index of 34, he was cannulated for venoarterial extracorporeal membrane oxygenation (ECMO). Following cannulation, his remaining PAVM were embolized. ECMO support was subsequently weaned and he was decannulated after 4 days. His ventilator support was weaned, and he was transferred back to the referring hospital on minimal settings. He was extubated the next day and quickly weaned to room air. He was discharged after 2.5 weeks and was doing well (SpO2=95%) at his pediatrician follow-up. DISCUSSION: This is the first case of a previously healthy child requiring cannulation for ECMO due to PAVM. This case is unique among patients with PAVM due to the early presentation, likely related to an acute respiratory illness disturbing previously well-compensated ventilation-perfusion mismatch. As highlighted in this case, ECMO can be used to support patients who require interventions for PAVM and during the transition to a new physiologic state.

10.
Pediatric Rheumatology ; 20(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1677519

ABSTRACT

Introduction: Multisystem inflammatory syndrome in children (MISC), also known as paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), is a condition characterised by persistent fever, elevation of inflammatory indexes and evidence of organs involvement or shock. Objectives: To describe clinical characteristics, diagnostic findings and therapeutic interventions of monocentric cohort of MIS-C. Methods: Diagnosis of MIS-C was done following CDC criteria. Patients were hospitalised at Santobono-Pausilipon Children's Hospital in Naples, Italy, from November 2020 to March 2021. Results: MIS-C was diagnosed in 29 patients, 14 males (48.3%). Mean age at diagnosis was 7,2 years old (range 4 months-12,9 years). Contact with SARS-CoV-2-positive patient emerged in 18/29 patients (62%) while 5/29 patients (17,2%) reported symptomatic COVID-19 in the weeks before. SARS-CoV-2 serologic assayrevealed IgG +/IgM- in 100% of the patients. No one presented concurrent conditions but obesity in 6/29 (20,7%). Mucocutaneous involvement was evidenced in 21/29 patients (72%), gastrointestinal symptoms 22/29 (75.9%), cardiac involvement in 27/29 (93,1%). The most frequent symptoms were fever (100%), conjunctivitis (65.5%), abdominal pain (62%), diarrhoea (48,2%), rash (44,9%), vomiting (31%) and cheilitis (31%). Laboratory findings are summarised in table 1. Troponin resulted elevated in 16/29 (55,1%), associated elevation of BNP was evidenced in 12/29 (62%). Electrocardiography showed alterations in 25/29 (86,2%) while echocardiography in 21/29 (72%). Concerning therapy, 27/29 (93%) patients underwent parenteral antibiotics at the admission. Intravenous immunoglobulin (IVIG) was performed in 25/29 (86,2%) of patients. Due to cardiac involvement 13/29 patients (44,8%) received bolus of steroids. 4/29 patients (13,8%) presented worsening of clinical and laboratoristic parameters during treatment with steroids, requiring Anakinra. One patient died due to cardiogenic shock at the admission. Conclusion: Mucocutaneous, gastrointestinal and cardiac involvement are the most common manifestations in our cohort, as also reported in literature. Biologic treatment was necessary in minority of patients. MIS-C is a new emerging condition and represent a challenge to paediatricians due to the severity of presentation. More data are needed to better define incidence and prognosis of that condition.

11.
Rheumatology (United Kingdom) ; 60(SUPPL 5):v29, 2021.
Article in English | EMBASE | ID: covidwho-1648321

ABSTRACT

Background With the wide spread of the current SARS-CoV-2, It was found that about 2% of children was affected according to several studies, However, a small number of children with Covid-19 develop a significant systemic inflammatory response similar to Kawasaki disease, a new disease entity called multisystem inflammatory syndrome. Methods A 12-year-old child, without a notable pathological history, who presented to the emergency, during the SARS-CoV-2 pandemic, for management of a pseudo-appendicular syndrome. Our patient was initially assessed by the surgical team due to his query acute abdomen. The pain had been evolving for 3 days associated with several episodes of bilious vomiting in a context of fever at 38.5°. Abdominal examination noted abdominal tenderness and defence. Extradigestive signs were not reported, The Lab Testing objectified a CRP at 235, elevated white blood cells at 18 180, an abdominal ultrasound was requested returning without particularities. Faced with the persistence of bilious vomiting, surgical exploration was indicated objectifying a catarrhal appendix. A pediatric opinion was requested, the clinical examination shows conscious child who presents infra cervical lymphadenopathy with a fever at 38 associated with an erythematous skin rash on the back and aseptic conjunctivitis. The Lab Testing objectified an important inflammatory syndrome, a acute kidney and heart failure a Covid 19 serology was requested with positive IGG, négative IGM, PCR covid test was negative, given the unavailability of In immunoglobulins, the treatment was based on corticosteroid bolus then relay by oral corticosteroid associated with an anti-inflammatory treatment, gastric protection by proton pump inhibitors, treatment of heart and acute kidney failure. The evolution was marked by clinical and biological improvement Discussion Coronavirus 2 (SARS-CoV-2) infection among children and adolescents, is mainly responsible for mild respiratory symptoms, in contrast to the severe forms reported in adults [7]. A systemic inflammatory syndrome mimicking kDa, temporally associated with infection with SARS-CoV-2 (Kawa-COVID-19) has recently been described as a serious illness sometimes requiring intensive care (44%). The median age is older (> 5 years), the frequency and severity of myocarditis are very different from classic kDa, abdominal pain and/or diarrhea were more frequently (81%) reported than in classic kDa, heart failure, pneumonia, neurological and renal impairment, associated with elevated CRP, hyperferritinemia are more common in Kawasaki-Like syndrome [10]. Some investigations must be systematically realized urgently to diagnose potentially fatal complications. These include testing for myocarditis, patients should benefit from careful monitoring and treatment with IV Ig 2 g/kg should be administered rapidly and seems to be effective in the majority of cases, associated antiinflammatory therapy, such as steroids is necessary Conclusion Pediatricians should be aware of these atypical presentations of COVID-19 infection for early diagnosis.

12.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617072

ABSTRACT

Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.

13.
Paediatrics and Child Health (United Kingdom) ; 2022.
Article in English | EMBASE | ID: covidwho-1616687

ABSTRACT

Prevention is better than cure. Early help for children is the total support that improves a family's resilience and outcomes, or reduces the chance of a problem getting worse. Early help has been likened to a fence at the top of the cliff, rather than the ambulance at the bottom. However, many healthcare systems have tended to under invest in services that reduce demand to acute services. In the UK it has been difficult to plan a whole system approach to early help across a local area. Austerity and the COVID-19 pandemic have brought further challenges to disadvantaged families, NHS, local authorities, police, schools and other local partners. However, a new model of early help is emerging, in collaboration with partners, with communities and with families. By pro-actively reaching out and compassionately supporting families before their needs escalate, through a new category of service delivery, we are able to reduce future demand as well as providing more human engagement and help. This paper includes an overview of early help design, emerging changes that paediatricians will contribute to in their localities, the national vision, and an example from Birmingham Children's Partnership that shows how an early help response supported families through the pandemic.

14.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e102-e104, 2021.
Article in English | EMBASE | ID: covidwho-1584132

ABSTRACT

BACKGROUND: Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience;however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. OBJECTIVES: To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. DESIGN/METHODS: The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. RESULTS: The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with > 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing < 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with = 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). CONCLUSION: A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

15.
Blood ; 138:4966, 2021.
Article in English | EMBASE | ID: covidwho-1582371

ABSTRACT

Introduction: Clinicians in academia face four major career challenges: 1. Gaining clinical advice from colleagues experienced in a particular disease or treatment 2. Experiencing Life-long coaching and mentoring from senior experienced clinicians 3. Accessing high quality continuing medical education relevant for patient care 4. Support to carry out medical research All four challenges have been adversely impacted during the Covid-19 pandemic as traditional face-to-face networks have become harder to access. This is especially pertinent when treating complex or rare diseases like acute lymphoblastic leukemia (ALL). Atypical or refractory patients, and those who experience toxicities often benefit from timely input from experts with considerable experience managing ALL. Online networks offer a robust pandemic-proof source of health and care support and advice. Until recently there have been few dedicated professional networks that provide a regular online forum dedicated to research and care on specific diseases across countries and none related to ALL. Methods: We describe the Resonance ALL Research and Care Network (ALL RCaN;https://resonancehealth.org/networks/all-rcan ) which includes a network of colleagues and a weekly, multidisciplinary online forum that brings together pediatric and adult hematologists and oncologists from around the world to share data, discuss cases and support patient care. In addition, there is a monthly ‘Fellows Fourth Friday’ to help fellows build their own professional network and gain scientific and clinical advice. The network was born out of a monthly meeting of study chairs (the “Study Chair Affinity Group”) for ALL research protocols which had been running for 10 years. Results: The network launched formally in June 2020 with 30 founding members but has expanded rapidly through word of mouth. The Acute Leukemia network grew by 850% by Dec 2020 and 1460% by March 2021 and as of July 2021 has 579 members across 18 time zones. It has succeeded in 'Building ALL Bridges“ between physicians that treat adults and pediatricians for joint discussions in acute leukemia. This collaboration has been severely lacking in the past. The network also presents selected s from major national and international conferences every 4 weeks. This model has been replicated for other cancers including the Global Neuroblastoma Network (resonancehealth.org/networks/gnn) and High-dose Methotrexate Quality Improvement Network (resonancehealth.org/networks/hdmtx). Network software development, video conferencing, meeting coordination, and content hosting have been funded by volunteer network leaders, many volunteer presenters, philanthropic contributions, and unrestricted educational grants. Now that the Resonance infrastructure is fully developed (and available to all at no cost), most Networks function well without funding. Conclusions: Providing free video conferencing, content hosting, and network management tools combined with dedicated leadership and clinically relevant discussions and presentations has led to massive growth of the ALL Research and Care Network, which continues to grow. Networks for other cancers are in various stages of development since the tool set and methodology easily scales to new groups of colleagues and new diseases. [Formula presented] Disclosures: Guscott: EUSA Pharma UK Ltd: Ended employment in the past 24 months. Douer: Amgen: Consultancy, Speakers Bureau;Servier: Consultancy, Speakers Bureau;Jazz: Consultancy;Adaptive: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company, Speakers Bureau. Howard: Cellworks Group Inc.: Consultancy;Sanofi: Consultancy, Other: Speaker fees;Servier: Consultancy.

16.
Medico e Bambino ; 40(9):558, 2021.
Article in Italian | EMBASE | ID: covidwho-1579113
17.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):570-571, 2021.
Article in English | EMBASE | ID: covidwho-1570363

ABSTRACT

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short term (6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland (HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Method: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusion: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in -even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID- 19 era.

18.
Przeglad Pediatryczny ; 49(4):10-16, 2020.
Article in Polish | EMBASE | ID: covidwho-1567582

ABSTRACT

Recently, a significant increase in the number of patients infected with SARS-CoV-2 has been observed, including children. The available data indicate, that children are less sus-ceptible to SARS-CoV-2 infection compared to adults and may play a lesser role in the transmission of the infection. Children get infected much less frequently than adults, most of them do not have comorbidities, and in 80-90% of cases in children, the clinical course of COVID-19 is mild (oligo-or asymptomatic). The aim of this paper is to discuss the management of a child with COVID-19 in outpatient and inpatient settings. The current options and indications for antiviral therapy (including remdesivir), tociliziumab, and convalescent plasma, were discussed, indicating the limited availability of therapies in children. The mainstay of COVID-19 treatment in most pediatric patients is symptomatic and supportive treatment as well as measures aimed at reducing the spread of SARS-CoV-2 infection.

19.
Vaccines (Basel) ; 9(11)2021 Oct 20.
Article in English | MEDLINE | ID: covidwho-1538556

ABSTRACT

(1) Background: Children with chronic medical conditions may be at increased risk for severe complications related to vaccine-preventable infections. Therefore, additional booster doses or supplementary vaccines are recommended, over and above the routine immunization schedule for healthy children. The aim of this study was to investigate attitude, knowledge, and practices toward additional vaccinations for children affected by chronic conditions among pediatricians and parents. (2) Methods: This study is based on two surveys: (i) a national cross-sectional survey, targeting pediatrician working in hospitals or in the primary health sector; (ii) a local cross-sectional survey, targeting parents of children with a previous diagnosis of chronic disease. (3) Results: Despite the fact that most of the health professionals and parents interviewed had an overall positive vaccine attitude, most pediatricians did not show an adequate knowledge of additional vaccinations for children affected by chronic diseases. Moreover, the coverage of additional recommended vaccinations in chronic pediatric patients was low. (4) Conclusions: This research highlighted important existing challenges hampering optimal vaccination coverage among pediatric chronic patients, including knowledge gaps on tailored vaccination schedules among pediatricians and organizational issues. The ongoing review of the Italian national immunization plan is a not-to-be-missed-opportunity to include evidence-based, detailed, and comprehensive recommendations on vaccinations for children affected by chronic conditions.

20.
Health Serv Insights ; 14: 11786329211036855, 2021.
Article in English | MEDLINE | ID: covidwho-1438222

ABSTRACT

The ECHO (Extension for Community Health Outcomes) model has been introduced and implemented in several hospitals and health programs in Vietnam since 2015. In 2018, Vietnam National Children's Hospital (VNCH) officially implemented the ECHO model to provide continuing medical education (CME) credits on pediatrics topics for medical staff in its satellite hospitals and health centers in the Northern region of Vietnam. This paper presents preliminary results of the ECHO program at VNCH. Methods included pre- and post-program assessments of pediatricians' clinical knowledge, self-efficacy, and professional satisfaction. The analysis compared the differences between pre/post scores descriptively. Knowledge of participants increased by 22.5% points on average. More than 90% of Project ECHO-Pediatrics participants experienced increased confidence. Overall, there was an improvement in participants' self-efficacy in the post-training compared to the pre-training (range 14.7%-22.6% difference from pre-training). All participants improved on their results in the clinical test immediately after the training and maintained it after 3 months. The study demonstrated the ability Project ECHO to improve healthcare worker knowledge and satisfaction.

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