Comparison of Safety and Effectiveness between Levetiracetam and Phenytoin in the Treatment of Pediatric Status Epilepticus: A Meta- Analysis.

OBJECTIVE: To evaluate the safety and effectiveness of levetiracetam and phenytoin by evaluating the events of seizure termination and recurrence in children. METHODS: We used the internet databases PubMed, Embase, and Google Scholar to conduct a literature search for the appropriate studies. A meta-analysis was performed to calculate the odds ratio using fixed and random-effects models. RESULTS: We identified 15 studies that were eligible for the meta-analysis. The incidence of seizure termination within 24 h was 76.9% for levetiracetam and 70.5% for phenytoin. Levetiracetam had a higher number of seizure termination events than phenytoin (P = 0.005, I2 = 66%). The incidence of seizure recurrence within 24 h was 10% for levetiracetam and 15.6% for phenytoin. Phenytoin had a significantly higher number of seizure recurrence events than levetiracetam (P = 0.00007, I2 = 21%). CONCLUSION: The efficacy and safety of levetiracetam are superior to that of phenytoin in children with status epilepticus. Large Randomized Controlled Trial studies are needed to confirm the result in children.

The Association Between Admission Sources and Outcomes at a Pediatric Intensive Care Unit in Al-Ahsa, Saudi Arabia: A Retrospective Cohort Study.

Objectives In this study, we aimed to examine the association between sources of admission (either intra-hospital transfers or ED admissions) in pediatric intensive care units (PICUs) and the discharge rate, mortality rate, and referral over a period of three years. We also sought to identify the independent predictors of discharge and mortality rate in the study population. Patients and methods This was a retrospective cohort study involving the analysis of 2,547 patients' data collected from the Pediatric Intensive Care Registry of a secondary care community hospital. We included patients admitted to the PICU from January 1, 2016, till December 31, 2018, who were aged 0-14 years with a specific diagnosis, recorded source of admission, and clear outcome. Data were collected, coded, and analyzed using the SPSS Statistics software (IBM, Armonk, NY) and STATA software (StataCorp, College Station, TX). Results Of the included patients, 1,356 (53.2%) were males, and 1,191 (46.8%) were females. Infants were associated with an increased risk of a long stay in the hospital [relative risk ratio (RRR)=5.34, 95% CI: (1.28, 22.27)] and mortality [RRR=3.56, 95% CI: (1.41, 8.95)] compared to older children. Similarly, neonates were associated with a higher risk of mortality [RRR=2.83, 95% CI: (1.05, 7.65)]. Patients who were admitted through ED were associated with a lower risk of a long-stay [RRR=0.56, 95% CI: (10.36, 0.87)] and mortality [RRR=0.68, 95% CI: (0.49, 0.95)] compared to intra-hospital transfers. Concerning the admission date, all time periods were associated with a lower risk of mortality compared to the period of October-December. Conclusion Our findings showed that the age of patients, source of admission, and date of admission might be used as independent predictors for determining the outcome of admissions, including discharge and mortality rates. Further studies are required to confirm these findings.

Multisystem Inflammatory Syndrome in Children, the Real Disease of COVID-19 in Pediatrics - A Multicenter Case Series From Al-Ahsa, Saudi Arabia.

Fortunately, coronavirus disease 2019 (COVID-19) infection in pediatric populations exhibits a mild course of disease. However, a small number have recently been identified who develop a significant systemic inflammatory response, a new disease entity called multisystem inflammatory syndrome in children (MIS-C), especially after the peak of the wave in Al-Ahsa, Saudi Arabia, in early June to mid-July. In MIS-C children usually present a few days to a few weeks after recovery from COVID-19 with high grade fever, GI symptoms, Kawasaki-like picture or even toxic shock-like syndrome. Raising awareness about this disease entity is very fundamental to enable pediatricians and other health care providers to identify and manage these patients before it is too late. We describe 10 different cases of MIS-C with different risk factors and presentations.