Development and validation of the predictive score for pediatric COVID-19 pneumonia: A nationwide, multicenter study.

BACKGROUND: Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation. METHODS: This was a retrospective cohort study done by chart review of all children aged 0-15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort. RESULTS: The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491-0.602) in the low-risk category, 1.563 (95% CI: 1.454-1.679) in the moderate, and 4.339 (95% CI: 2.527-7.449) in the high-risk. CONCLUSION: This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.

Factors Associated with Failure of Intermittent Nebulization with Short-Acting Beta-Agonists in Children with Severe Asthma Exacerbation.

PURPOSE: Intermittent nebulization of short-acting beta-agonists (SABA) is the initial treatment of choice for children with asthma exacerbation. However, children with severe asthma exacerbation (SAE) may not show an adequate response and need aggressive stepwise therapy. We aimed to explore factors associated with a poor response to intermittent nebulized SABA in children with SAE. METHODS: A retrospective cohort study of children with SAE diagnosed according to the definition of the British Guidelines on the Management of Asthma, who were admitted at Hat Yai Hospital from January 1, 2015, to December 31, 2017. All children were treated with intermittent SABA nebulization. Treatment failure was defined as children needing escalated therapy. Logistic regression with confounding score adjustment was used to explore the predictors of treatment failure. RESULTS: One hundred thirty-three children were included in the analysis, 59 were in the failure group and 74 were in the success group. After adjusting for potential confounders, they were significantly associated with a previous history of intubation (adjusted OR 6.46, 95% CI 1.13 to 36.79, p=0.036), receiving <3 doses of nebulized salbutamol in the emergency room (ER, aOR 3.21, 95% CI 1.15 to 9.02, p=0.027), ER measured oxygen saturation (SpO2) <92% (adjusted OR 3.02, 95% CI 1.18 to 7.75, p=0.022), and exacerbation triggered by pneumonia (adjusted OR 2.67, 95% CI 1.19 to 6.00, p=0.017). CONCLUSION: We identified four prognostic factors of treatment failure in children with SAE: a previous history of intubation; receiving <3 doses of nebulized salbutamol in the ER, SpO2 at ER <92%; and exacerbation triggered by pneumonia. Further prospective studies are required to confirm our findings before clinical implementation.

Continuous versus intermittent short-acting ß2-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis.

BACKGROUND: Short-acting ß2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments. METHODS: An efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1-4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups. RESULTS: One-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3, p < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22, p < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference - 9.9 h, 95% CI -24.2, 4.4, p = 0.176). CONCLUSION: Continuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.

Nomogram for prediction of the risk of neonatal hyperbilirubinemia, using transcutaneous bilirubin.

Assessing the risk of developing severe hyperbilirubinemia, based on a nomogram has been recommended by the American Academy of Pediatrics. The objectives of this study were: 1) To develop an hour-specific nomogram, using transcutaneous bilirubin level (TCB, Bilicheck, SpecRx, Inc, Norcross, GA, USA), in Thai newborn infants and 2) To determine the risk zones that will predict the development of severe hyperbilirubinemia. Three hundred and ninety two (392) healthy neonates, born by C-section, were recruited from November 2003 to May 2004. One hundred and eight (108) infants were excluded from the nomogram development due to hemolytic diseases (ABO incompatibility 51, G6PD deficiency 34, combined ABO incompatibility and G6PD deficiency 3) and requirement of phototherapy (20). Nomogram, using daily hour-specific TcB for 4 days, of 284 neonates was constructed Plotting all 392 infants, TcB on the nomogram, the risk zones in relation to the requirement of phototherapy was determined. The 90th percentile (P90) was designated as high risk track with the sensitivity of 96.9%, specificity 78.8%, positive and negative predictive values 29.1% and 99% respectively, and LR 4.6. P10 was labeled as very low risk track, area between P10-P25 as low risk zone, P25-P90 as intermediate zone with P25-P50 as low intermediate and P50-P90 as high intermediate. In conclusion, an hour-specific TcB nomogram, can be used to identify the risk of subsequent development of severe hyperbilirubinemia. Recognizing the infants risk enables awareness of the problem and prompt intervention which should reduce severe hyperbilirubinemia and chance to develop bilirubin encephalopathy.