Non-polio enterovirus aseptic meningitis in infants up to three months of age, the bacterial mask of viral disease: A retrospective cohort study.

BACKGROUND: Non-polio enterovirus aseptic meningitis (NPE-AM) is a self-limiting illness that can mimic serious bacterial infection (SBI) in infants during their first months of life. OBJECTIVES: To compare the clinical features of febrile infants diagnosed with NPE-AM with those of infants who had SBI or non-bacterial infection (NBI). STUDY DESIGN: A systematic series of febrile infants < 3-months-old hospitalized between 2010 and 2019 with febrile illness in a tertiary hospital. Clinical and laboratory data were compared between the three groups. RESULTS: Overall 1278 infants were included; 207 (16.2%) had NPE-AM, 210 (16.4%) SBI and 861 (67.4%) NBI. The median age was 34 (IQR: 21.5-51.7) days. NPE-AM was documented in 25% of infants < 29 days and 9.9% of infants aged 29-90 days. Infants with NPE-AM or SBI had fever >39°C more frequently, 24.2% and 17.1% compared with 10% in infants with NBI (p < 0.001). Fever duration ≥ 2 days was reported in 3.4% of infants with NPE-AM vs 18.6% in SBI and 26.3% in NBI (p < 0001); rash occurred in 37.7% in NPE-AM compared to 4.6% in NBI and 5.7% in SBI (p < 0.001). The mean white blood count, C-reactive protein and absolute neutrophil count were significantly lower in infants with NPE-AM compared to infants with the SBI (p < 0.001) and similar to the means in infants with NBI (p = 0.848, 0.098 and 0.764 respectively). A high proportion of bloody tap 346/784 (53.1%) was detected. Infants with NPE-AM were more likely to be treated with antibiotics than infants with NBIs (88.9% vs 50.7%, p < 0.001), similarly to infants with SBIs (p = 0.571). CONCLUSIONS: The clinical presentation of infants with NPE-AM that could mimic bacterial infection and the high rate of bloody taps may lead to more hospital admissions and antibiotic prescriptions. Rapid molecular testing for detection of NPE may be of additional value in the evaluation of febrile infants.

The effect of an interventional program on the occurrence of medication errors in children.

OBJECTIVES: Medication errors in hospitalized children represent a serious health problem; these include dosing errors, administration route errors, errors in identifying the patient and more. The rates of medication errors are considered higher in children compared to adults because, among other reasons, the pediatric dose is calculated according to the child's weight or body surface. This study aims to examine the incidence of pediatric medication dosing errors and the impact of an intervention program in reducing these errors and related adverse effects in a cohort of hospitalized children at an otolaryngology department. METHODS: We reviewed 100 computerized medical reports of hospitalized children from 2017 to 2018, including 50 inpatient admissions prior to the implementation of an intervention program and 50 inpatient admissions following its implementation. Data includes demographic variables, number of hospitalization days, rates and types of medication errors and adverse effects. We have analyzed the rates of medication errors before and after implementation of an interventional program. RESULTS: The average patient age was 5.26 and the demographic features of the two groups were similar. We identified 23.2% medication dosing errors in medications prescribed to the patients (n = 33) and 17.6% medication dosing errors in total medications administered to the patients (n = 64) in the pre-intervention group (PREG). In the post-intervention group (POSG) we identified 10.6% medication dosing errors in prescriptions prescribed to the patients (n = 12) and 7% medication dosing errors in the total drugs administered to the patients (n = 21). The intervention program resulted in 46% reduction of prescription errors; No adverse effects were recorded. CONCLUSIONS: Medication dosing errors among hospitalized children are common, although rates of adverse events are low. The suggested intervention program demonstrates a significant reduction in the rates of these errors, thus improving the safety of hospitalized children.