Classification of SARS-CoV-2 Pediatric Hospitalizations: Delta vs Omicron Variant.

OBJECTIVES: To classify COVID-19 pediatric hospitalizations based on reason for admission ("for COVID" or "with COVID") and to compare disease severity and age between the delta and omicron variant predominant time frames. METHODS: This was a retrospective study in patients aged ≤18 years who were hospitalized at a large, tertiary care pediatric hospital for COVID-19 from July 2021 to February 2022. Disease severity was determined based on length of stay, PICU admission, and Remdesivir receipt. A χ2 analysis and a Cochran-Mantel-Haenszel test were used to analyze relationships between presumed variant type with admission reason, disease severity, and age. RESULTS: There were 492 patients included with more admissions during the omicron variant predominant time frame (n = 307). More patients were admitted "for COVID" during the delta variant predominant time frame compared with the omicron variant predominant time frame (P < .001) with interrater reliability testing indicating substantial agreement between reviewers. PICU admissions (P < .001), receipt of remdesivir (P < .001), and length of stay (P < .001) were greater during the delta variant predominant time frame. Hospitalizations "for COVID" were more common in patients aged <5 years during both the delta (odds ratio, 2.6; 95% confidence interval, 1.2-5.7) and omicron (odds ratio, 5.7; 95% confidence interval, 3.4-9.4) predominant time frames compared with older patients. CONCLUSIONS: There was a higher proportion of symptomatic COVID-19 hospitalizations with higher disease severity during the delta variant predominance, indicating greater disease severity during earlier periods of the pandemic despite lower hospitalization rates.

Common Food and Drug Interactions.

Food-drug interactions should be suspected when a patient is taking their medications as directed and doses are optimized yet therapy is still not optimal (increased adverse effects, decreased efficacy, new adverse effects, etc). In all individuals with suspected food-drug interactions, diet history, baseline laboratory values, drug concentrations, and prescription history are recommended to assess the patient for a possible food-drug interaction. The 3 types of food-drug interactions are pharmaceutical, pharmacokinetic, and pharmacodynamic. Pharmaceutical interactions occur with delivery devices or enteral feeding products. Pharmacokinetic interactions include the processes of a drug's release, absorption, distribution, metabolism, and/or elimination, ultimately affecting the effectiveness and safety of therapy. Pharmacodynamic interactions occur when food alters a drug's clinical effect on the body. The most common food-drug interactions exist with fruits (especially grapefruit), dairy, vitamin K, tyramine-containing foods, and alcohol. Patient counseling and collaboration between health-care teams can help patients avoid food-drug interactions. As a result, medication therapy can be optimized and adverse effects can be avoided.