COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic.

Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups in the US where long-standing health issues and structural inequities are now known to have resulted in increased risk for infection, severe illness, and death from the virus. The objective of our study was to describe demographic characteristics, clinical presentations, medical interventions and outcomes of pediatric patients with COVID-19 treated at Children's Hospital of Michigan (CHM), a tertiary care center in urban Detroit, an early hotspot during the initial surge of the SARS-CoV-2 pandemic. Methods. A retrospective chart review was performed of children ≤18 years of age who had polymerase chain reaction (RT-PCR) testing via NP swab or serum IgG antibody testing for SARS-CoV-2 during March 1, 2020-June 30, 2020. Results. Seventy-eight COVID-19 infected children were identified of whom 85.8% (67/78) were from minority populations (African American, Hispanic). Hospitalization rate was 82% (64/78). About 44% (34/78) had an associated comorbidity with asthma and obesity being most common. Although all ages were affected, infants <1 year of age had the highest hospitalization rate (19/64, 30%). In all disease severity categories, dichotomized non-whites had more severe disease by percentage within race/ethnicity than Whites, and also within percent disease severity (P-value = .197). Overall, 37% of hospitalized patients required intensive care. Conclusions. Extremely high rates of COVID-19 hospitalization and requirement of ICU care were identified in our patient population. Further studies are needed to better understand the contributing factors to this health disparity in disadvantaged communities.

Epidemiology of Invasive Fungal Infections at Two Tertiary Care Neonatal Intensive Care Units Over a 12-Year Period (2000-2011).

We conducted a retrospective review of 168 patients with invasive fungal infections from January 2000 to December 2011 in 2 neonatal intensive care units. Patients with Candida bloodstream infection (BSI, n = 152) were further analyzed. C albicans was the most common species overall (47%); however, there was an increase in non-albicans sp from 2006 to 2011. Candida BSI clearance rates were lower in extremely low birth weight infants (77% vs 93%, P = .01) and in patients with C albicans infections (77% vs 91%, P = .01). Clearance rates improved from 2000 to 2005 (70% - 90%) to 2006 to 2011 (86% -100%). Combination antifungal use increased during the later years (73% vs 49%, P < .05) and in patients with end-organ dissemination (83% vs 54%, P < .05). We concluded that extremely low birth weight infants and C albicans infection are factors associated with nonclearance of Candida BSI. Successful clearance of Candida BSI improved in 2006 to 2011, perhaps due to increase in non-albicans species and the use of combination antifungals.

A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants.

OBJECTIVES: The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers. METHODS: A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated. RESULTS: The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 consecutive days of study intervention compared with control (13.79 vs 10 lytic units, respectively; P = .04). Infants in the massage group were heavier at end of study and had greater daily weight gain compared with those in the control group; other immunologic parameters, number of infections, and length of stay were not different between the 2 groups. CONCLUSIONS: In this study, MT administered to stable preterm infants was associated with higher NK cytotoxicity and more daily weight gain. MT may improve the overall outcome of these infants. Larger studies are needed.

Vancomycin-resistant Enterococcus faecium endocarditis in a premature infant successfully treated with linezolid.

A 4 1/2-month-old, 26-week premature infant with multiple complications of prematurity required a central venous catheter for venous access and antibiotic treatment of bacterial nosocomial infections. He developed tricuspid valve endocarditis with vegetation caused by Enterococcus faecium resistant to ampicillin, vancomycin and quinupristin-dalfopristin but susceptible to linezolid. He was successfully treated with linezolid intravenously (7 weeks) and then orally (2 weeks).