Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain.

BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

Delayed sleep timing and circadian rhythms in pregnancy and transdiagnostic symptoms associated with postpartum depression.

Later sleep timing, circadian preference, and circadian rhythm timing predict worse outcomes across multiple domains, including mood disorders, substance use, impulse control, and cognitive function. Disturbed sleep is common among pregnant and postpartum women. We examined whether sleep timing during third trimester of pregnancy predicted postpartum symptoms of mania, depression, and obsessive-compulsive disorder (OCD). Fifty-one women with a previous, but not active, episode of unipolar or bipolar depression had symptoms evaluated and sleep recorded with wrist actigraphy at 33 weeks of gestation and 2, 6, and 16 weeks postpartum. Circadian phase was measured in a subset of women using salivary dim light melatonin onset (DLMO). We divided the sample into "early sleep" and "late sleep" groups using average sleep onset time at 33 weeks of gestation, defined by the median-split time of 11:27 p.m. The "late sleep" group reported significantly more manic and depressive symptoms at postpartum week 2. Longer phase angle between DLMO and sleep onset at 33 weeks was associated with more manic symptoms at postpartum week 2 and more obsessive-compulsive symptoms at week 6. Delayed sleep timing in this sample of at-risk women was associated with more symptoms of mania, depression, and OCD in the postpartum period. Sleep timing may be a modifiable risk factor for postpartum depression.

Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study.

BACKGROUND: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. OBJECTIVE: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. METHODS: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)-a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. CONCLUSIONS: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course.

Trombosis venosa profunda secundaria a canalización de vena femoral en niños con cetoacidosis diabética / Deep venous thrombosis secondary to femoral vein catheterization in children with diabetic ketoacidosis

Los niños ingresados por cetoacidosis diabética (CAD) suelen manejarse con vías periféricas; sin embargo, algunos pacientes necesitan un catéter central para el manejo inicial. Es sabido que la CAD implica un estado de hipercoagulabilidad que supone un aumento del riesgo de trombosis asociada a catéter. Se presentan 2 casos de trombosis femoral asociada a canalización de vena femoral coincidiendo con cetoacidosis diabética en lactantes de 18 y 27 meses. En ambos la trombosis fue precoz (antes de 72 h tras la inserción) y se desarrolló a pesar de la rápida retirada de la vía central (menor de 48 h). Debido al alto riesgo de trombosis asociada a catéter en los pacientes diabéticos más pequeños (menores de 3 años), debe considerarse individualmente la necesidad de catéter central y evitarlo siempre que sea posible. En caso de canalización, debe valorarse la profilaxis con heparina de bajo peso molecular (AU)

Children admitted to hospital for diabetic ketoacidosis are frequently managed with peripheral venous lines. However, due to the severity of their illness, some patients need central lines for initial treatment. Diabetic ketoacidosis is known to produce hypercoagulability, increasing the risk of catheter-related deep venous thrombosis. We present two patients with diabetic ketoacidosis, aged 18 and 27 months, who developed deep venous thrombosis after placement of femoral central venous catheters. In both patients, the thrombosis occurred within 72 hours of catheter insertion, despite rapid removal of the central lines (less than 48 hours). Due to the high risk of catheter-related thrombosis in patients with diabetic ketoacidosis (especially in children aged less than 3 years old), the need for central venous lines should be evaluated in each patient and avoided as far as possible. Low molecular weight heparin prophylaxis should be considered if a venous central catheter is required (AU)

La consulta de pediatria i l’adopció / No disponible

No disponible

Incidencia de calcificación del anillo mitral en dos grupos de pacientes renales cronicos con y sin hemodiálisis: reporte ecocardiográfico / Incidence of mitral ring calcification in two groupe of patients with chronic renal failure with and without hemodialysis : echocardiographic report

Se realizó un estudio prospectivo de 24 pacientes renales crónicos (Grupo A = 12 pacientes hemodializados y Grupo B = 12 pacientes no hemodializados). La CAM (Calcificación del Anillo Mitral) se observó en 10 pacientes del Grupo A (83.3 por ciento ) y en 3 pacientes del Grupo B (25 por ciento ), P < 0.05. La hipertensión arterial como uno de los principales factores predisponentes se encontró en los 12 pacientes del Grupo A (100 por ciento ) y en 4 del Grupo B (33.3 por ciento ). El fósforo serico tuvo una media aritmética de 6.9 mg/dL, en el Grupo A y de 4.8 mg/dL, en el Grupo B. La media aritmética del producto Calcio-Fósforo en el Grupo A fue de 63 (mg/dL) y en el Grupo B 42.5 (mg/dL)