Cambios a partir de la COVID-19. Una perspectiva desde la pediatría interna hospitalaria / Changes from COVID-19. A perspective from internal pediatric medicine

La dimensión de la pandemia por SARS-CoV-2 ha afectado a la organización asistencial de la pediatría hospitalaria de nuestro país. Los nuevos retos generados por la COVID-19 exigen una serie de medidas proactivas basadas en los conocimientos científicos existentes y las normas de buena práctica que permitan la preparación y la mayor operatividad de los servicios pediátricos hospitalarios. La pediatría interna hospitalaria, como responsable de la atención integral del niño hospitalizado, tiene un papel principal en el nuevo modelo de hospital surgido de esta epidemia. En la presente revisión se analiza la repercusión pediátrica que ha tenido la epidemia por SARS-CoV-2 y la preparación ante futuros rebrotes, en posible coexistencia con otras infecciones virales. Se revisa también la implicación de las unidades pediátricas en la asistencia de adultos y la atención de pacientes crónicos complejos, y se ofrecen recomendaciones sobre aspectos de seguridad, consideraciones éticas y docencia de los futuros pediatras durante la crisis. La Sociedad Española de Pediatría Hospitalaria (SEPHO) pretende con este documento ofrecer a los pediatras internistas hospitalarios una serie de reflexiones y recursos de utilidad en un escenario con muchas incertidumbres

SARS-CoV-2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV-2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital Pediatric units, how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement need to be revised. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal Pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units

Changes from COVID-19. A perspective from internal pediatric medicine.

The SARS-CoV2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital pediatric units must be analyzed, and how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units.

La dimensión de la pandemia por SARS-CoV2 ha afectado a la organización asistencial de la Pediatría Hospitalaria de nuestro país. Los nuevos retos generados por la COVID-19 exigen una serie de medidas proactivas basadas en los conocimientos científicos existentes y las normas de buena práctica, que permitan la preparación y la mayor operatividad de los servicios pediátricos hospitalarios. La Pediatría Interna Hospitalaria, como responsable de la atención integral del niño hospitalizado, tiene un papel principal en el nuevo modelo de hospital surgido de esta epidemia. En la presente revisión se analiza la repercusión pediátrica que ha tenido la epidemia por SARS-CoV2 y la preparación ante futuros rebrotes, en posible coexistencia con otras infecciones virales. Se revisa también la implicación de las unidades pediátricas en la asistencia de adultos y la atención de pacientes crónicos complejos y se ofrecen recomendaciones sobre aspectos de seguridad, consideraciones éticas y docencia de los futuros pediatras durante la crisis. La Sociedad Española de Pediatría Hospitalaria (SEPHO) pretende con este documento ofrecer a los pediatras internistas hospitalarios una serie de reflexiones y recursos de utilidad en un escenario con muchas incertidumbres.

[Changes from COVID-19. A perspective from internal pediatric medicine]. / Cambios a partir de la COVID-19. Una perspectiva desde la pediatría interna hospitalaria.

SARS-CoV-2 pandemic dimension has affected the Hospital Pediatrics Medicine assistance in our country. New challenges generated by COVID-19 require a series of proactive measures, based on existing scientific knowledge and standards of good practice, that allow the Pediatric Hospital services readiness and operability. Hospital Internal Pediatrics, as responsible of integral care of the hospitalized child, plays a leading role in the new hospital model emerging from this crisis. This review analyzes the impact of the current SARS-CoV-2 epidemic on pediatric care, and perspective of new COVID-19 outbreaks in coexistence with other viral infections. Changes secondary to pandemic involved in Hospital Pediatric units, how to prepare for future epidemics, also the involvement of pediatric units in adult care and the possible opportunities for improvement need to be revised. Assistance of patients with chronic complex conditions in epidemic circumstances, safety aspects, opportunities for teaching and ethical considerations are reviewed. The Spanish Society of Hospital Pediatrics Medicine offers with this article a series of resources for Internal Pediatric Medicine practitioners responsible to face next challenges in pediatric hospitalization units.

Hereditary pulmonary alveolar proteinosis. Could it be triggered by Mycoplasma pneumoniae pneumonia?

We present a three-year-old girl with respiratory failure due to hereditary pulmonary alveolar proteinosis caused by abnormal alpha chain of the granulocyte-macrophage colony-stimulating factor receptor. Both the patient and an asymptomatic seven-year-old sister were homozygous for the same mutation in CSF2RA. We speculate that the Mycoplasma pneumoniae pneumonia might have triggered the clinical presentation. While a good response to serial partial lung lavage was noticed, the ultimate outcome is uncertain.

Impact of rapid viral testing for influenza A and B viruses on management of febrile infants without signs of focal infection.

BACKGROUND: The objective of this study was to assess the effect of rapid testing for influenza virus on management of febrile young infants. METHODS: During 2 influenza seasons (November to December 2003 and December 2004 to February 2005), we studied prospectively infants who were 0 to 36 months of age who presented to the emergency department (ED) with fever in the absence of signs of focal infection. The Directigen Flu A+B test was used to determine infection with influenza virus types A or B. Confirmatory viral cultures were not done. RESULTS: Rapid influenza testing was performed in 206 infants and 84 (40.7%) of them were influenza-positive. Infants with a positive and a negative influenza test showed a similar mean (standard deviation) age (6.86 [6.3] versus 6.55 [6.8] months) and mean temperature (39.38 degrees C [0.6] versus 39.32 degrees C [0.8]), but there were significant differences (P < 0.01) in the percentage of patients undergoing blood tests (33.3% versus 100%), urinalysis (80.9% versus 100%), chest roentgenogram (14.2% versus 32%), cerebrospinal fluid analysis (1.33% versus 21.3%), mean length of stay in the ED (116.2 [75.5] versus 192.9 [76.3] minutes), admission to the ED observation ward (8.3% versus 21.3%), inpatient care (2.3% versus 16.4%) and antibiotic treatment (0% versus 38.5%). All positive bacterial cultures occurred among influenza-negative patients. CONCLUSIONS: The inclusion of rapid influenza testing for the evaluation of febrile young infants without signs of focal infection during influenza season decreases the need for additional studies and reduces the length of stay in the ED, the use of antibiotic treatment and unnecessary hospitalizations.

Salbutamol via metered-dose inhaler with spacer versus nebulization for acute treatment of pediatric asthma in the emergency department.

OBJECTIVES: To assess the effectiveness of salbutamol delivered via a metered-dose inhaler with spacer versus a nebulizer for acute asthma treatment in the pediatric emergency department. METHODS: All consecutive children younger than 14 years old who required treatment of acute asthma exacerbation in the emergency department during May 2002 (prospective cohort, n = 321) and May 2001(retrospective cohort, n = 259) were included. Inhaled salbutamol was administered by metered-dose inhaler with a spacer (and a face mask in children younger than 2 years old) in the prospective cohort and by nebulizer in the retrospective cohort. RESULTS: There were no significant differences between the two cohorts in the mean (+/-SD) age (44.50 +/- 38.64 vs. 48.37 +/- 43.55 months) and asthma treatment, arterial oxygen saturation (96.34 +/- 2.12% vs. 96.19 +/- 6.32%), and heart rate (123.71 +/- 23.63 vs. 129.41 +/- 34.55 beats/min) before emergency department consultation. The number of doses of inhaled bronchodilators was also similar (1.42 +/- 1.01 vs. 1.45 +/- 0.98) as well as the number of children that required a stay in the observation unit, admission to the hospital, or returned for medical care. The overall mean length of stay in the emergency department was slightly shorter in the prospective cohort (82 +/- 48 vs. 89 +/- 52 minutes). CONCLUSIONS: The administration of bronchodilators using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the emergency department.

Factors associated with short-term clinical outcomes after acute treatment of asthma in a pediatric emergency department.

Outcomes of emergency room treatment of children with asthma have not been well-documented. The purpose of this study was to describe the short-term clinical course of children aged 0-14 years after standard treatment for an acute asthma exacerbation in a pediatric emergency department, and to determine factors associated with follow-up morbidity. This was a prospective cohort study of a randomly selected sample of children with asthma who required treatment for an acute asthma exacerbation during the year 2002. A clinical chart was filled out by the attending pediatrician during the emergency department visit. Participants were interviewed by telephone at 7 and 15 days after the pediatric emergency visit. The study population included 258 children; 125 of them (48.4%) were <2 years old. Eighty-nine percent of children reported a visit with his/her primary asthma care provider during the first week after discharge from the emergency department. A total of 185 children missed 1 or more days of school, with a mean of 3.1 +/- 2.7 days (range, 1-23 days). Twenty-nine patients (11%) returned for medical care at the emergency department, 22 (8.5%) of them during the first week after discharge, and 4 (1.6%) required hospitalization. At the first follow-up control (day 7), 111 patients (43%) reported persistent symptoms and/or difficult breathing, and 157 (61%) were still using asthma medication. At the second follow-up control (day 15), 53 patients (20.5%) reported persistent respiratory symptoms, and 69 (26.7%) used asthma medication. In children >2 years of age, the percentage of patients with respiratory symptoms on day 7 was significantly lower among those who reported maintenance therapy with inhaled steroids (23.7% vs. 46%, P = 0.006). On day 7, asthma symptoms were more frequent in children <2 years of age compared to older children showed a higher percentage of asthma symptoms (50% vs. 36%, P = 0.014). Children <2 years old compared to older children also missed more days school or day nursery (4.48 +/- 4.62 days vs. 2.4 +/- 2.19 days). The short-term outcome of asthma children attended at the emergency department is worse than expected, according to rates of rehospitalization and return for medical care after discharge. Maintenance treatment with inhaled steroids favored a prompt recovery in children older than 2 years of age, whereas the short-term outcome of children aged <2 years was not influenced by any variable.