Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients.

Guillain-Barré syndrome (GBS) is a recognised complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 who presented to a tertiary centre in Muscat, Oman in 2021: The first patient was a three-month-old female infant who presented with bradypnea, encephalopathy, and generalised weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a six-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery.

Outcome of Noninvasive Respiratory Support in Pediatric High-Dependency Units for Acute Respiratory Distress.

BACKGROUND: Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes. METHODS: We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. RESULTS: Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3-25) months and a median weight of 6.1 (IQR 4.3-10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1-3) d. At baseline, median SpO2 was 96% (IQR 90-99); median pH was 7.36 (IQR 7.31-7.41), and median PCO2 was 44 (IQR 36-53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5-108.0) h. On multivariable analysis, maximum FIO2 > 0.5 (odds ratio 4.49 [95% CI 1.36-14.9], P = .01) and PEEP > 7 cm H2O (odds ratio 3.37 [95% CI 1.49-7.61], P = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively. CONCLUSIONS: In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.

Critical pertussis: A multi-centric analysis of risk factors and outcomes in Oman.

OBJECTIVES: To identify risk factors and outcomes of patients with critical pertussis. DESIGN: Retrospective observational cohort study. SETTING: Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman. SUBJECTS: Children aged <13 years presenting to the emergency departments and diagnosed with laboratory-confirmed pertussis by polymerase chain reaction between January 2013 and December 2018. MEASUREMENTS AND MAIN RESULTS: In total, 157 patients were diagnosed with pertussis, of which 12% (n = 19) had critical pertussis. Patients with critical pertussis had a higher white blood cell count (WBCC) [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.08; P = 0.003], absolute lymphocyte count (ALC) (aOR 1.08; 95% CI 1.03-1.15; P = 0.004) and absolute neutrophil count (ANC) (aOR 1.05; 95% CI 1.01-1.10; P = 0.032) than patients with non-critical pertussis, even after multi-variate adjustment. The area under the curve for discriminatory accuracy of laboratory variables was 0.75 (95% CI 0.65-0.85), 0.74 (95% CI 0.64-0.84) and 0.72 (95% CI 0.60-0.83) for maximum WBCC, ALC and ANC, respectively, with Youden's cut-off values of 31.5 × 109/L, 19.9 × 109/L and 5.0 × 109/L, respectively. CONCLUSIONS: In children, higher WBCC, ALC and ANC were significant predictors of critical pertussis. A cut-off level of 31.5 × 109/L for WBCC was associated with critical pertussis.

Metformin-induced Lactic Acidosis Reported in the Youngest Pediatric Patient with Impaired Renal Function.

Metformin is a widely used biguanide for the treatment of type 2 diabetes mellitus. Metformin-induced lactic acidosis (MALA) is a rare but potentially fatal entity in the pediatric age group, seen mainly in suicide attempts in adolescents. MALA has not yet been reported in younger patients or pediatric patients taking regular therapeutic doses. Here, we report a three-year-old female receiving therapeutic metformin who developed MALA. MALA should be suspected in patients with unexplained lactic acidosis and on regular metformin, especially in the setting of renal impairment or hypoxic events.

A child with human parvovirus B19 infection induced aplastic anemia and acute hepatitis: effectiveness of immunosuppressive therapy.

Human parvovirus B19 (HPV B19) infections are usually asymptomatic or benign and self-limiting. In immunocompromised patients and patients with chronic hemolytic anemia, it can lead to transient red cell aplasia. Few reports in the literature have implicated HPV B19 as the possible cause of acute hepatitis and severe aplastic anemia in immunocompetent patients. Here, the authors report a previously healthy 6-year-old girl with acute hepatitis and severe aplastic anemia associated with HPV B19 infection diagnosed by serology (ELISA). Other common causes of these manifestations were ruled out. The clinical manifestations subsequently improved significantly with the use of immunosuppressive therapy confirming an autoimmune mechanism.