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Victor Daniel Miron,1 Oana Săndulescu,1,2 Mihai Craiu1,3 1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania; 3National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, RomaniaCorrespondence: Victor Daniel Miron, Carol Davila University of Medicine and Pharmacy, 127, Lacul Tei Street, Second District, Bucharest, 020382, Romania, Email victor.miron@drd.umfcd.ro

INTRODUCTION: Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children. METHODS: We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania between January 2017 and December 2019. We evaluated the patients’ clinical characteristics, laboratory parameters and the resistance profile of the identified uropathogens. RESULTS: A total of 264 children were included in the analysis. Females (71.6%, n=186) and infants (52.7%, n=139) were more commonly affected. The recurrence rate was 27.7% and was positively associated with the presence of renal malformations. Age under 1-year, increased leukocyte and neutrophil counts, and elevated C-reactive protein were associated with hospitalization. E. coli (80.3%, n=212) was the main etiological agent isolated, followed by Proteus mirabilis (9.8%, n=26) and Klebsiella spp. (6.4%, n=17). We identified increased resistance for all germs to common antibiotics used in pediatrics: ampicillin, amoxicillin/clavulanate, cefuroxime, ceftriaxone, and trimethoprim/sulfamethoxazole. CONCLUSIONS: We identified an increased resistance of uropathogens to antimicrobials commonly used in children. Reporting antimicrobial resistance from real-world clinical practice is necessary for accurate mapping and continuous updating of initial treatment recommendations until antibiogram results are received. In Romania and other countries, extensive studies are needed to follow up uropathogen resistance in both children and adults.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant condition characterized by cutaneous, cerebral, and other multiorgan involvement. Aneurysms due to TSC pathogenic mechanism are rarely present, mainly aortic, renal, or intracranial and very few associated with peripheral circulation. A TSC patient, aged 31 years, who developed brachial and subclavian arteries aneurysms is presented. The question of a random association of the aneurysms with TSC versus aneurysms within pathogenic released mammalian target of rapamycin (mTOR) pathway effect was raised.Patient's file, available from the age of six months, was analyzed for demonstration of the TSC diagnosis. Patient was examined, and cerebral magnetic resonance imaging (MRI) was repeated. Surgery and angiographic reports and images were reviewed. Pathology of the aneurysmal wall available from surgery was reexamined and special stainings and immunohistochemistry markers were applied. Genetic characterization of the patient was performed. Definite TSC was diagnosed based on major criteria [ungual fibromas, shagreen patch, cortical tubers, subependymal nodules (SENs), subependymal giant cell astrocytoma (SEGA)], minor criteria (confetti skin lesions, dental enamel pits, gingival fibromas), genetic result showing heterozygous variant in exon 8 of TSC1 gene (c.733CT-p.Arg245*). Pathology analysis revealed markedly thickened aneurysmal wall due to smooth muscle cells (SMCs) proliferation in media and neoformation vessels with similar characteristics in the aneurysmal wall.This is a rare case with aneurysms related to TSC, with an exceptional peripheral localization. Pathology exam is the key investigation in demonstrating the TSC-related pathogenic mechanism. A literature review showed 73 TSC cases presenting aneurysms published until now.

One of the affected organs in cystic fibrosis (CF) is the pancreas, mainly translated into exocrine pancreatic insufficiency. Although rare, acute pancreatitis (AP) has been described, mostly in pancreatic sufficient patients. Objectives. Estimating AP prevalence in CF pediatric population of the I.N.S.M.C. „AlessandrescuRusescu” CF centre. Material and methods. 5 year retrospective study (2011-2016) including INSMC CF centre pediatric population aged 3-18 years. PA diagnosis was established on the presence of minimum 2 criteria between: characteristic abdominal pain, x3 normal value for age elevation of amylase/lipase, medical imaging evaluation suggestive for AP. Patients were evaluated with different criteria including PIP score of predicting AP risk. Outcomes. 48 patients were included with a slight female predominance (54%). 3 of them presented diagnostic criteria for AP (6,25%), all heaving pancreatic insufficiency and high PIP score (low risk of developing AP); 2 of them have low compliance with pancreatic enzymes substitution therapy; one of them presented recurrent episodes of AP. Conclusions. AP is a rare CF complication. It can be easily missed due to a large number of abdominal pain and emesis causes in CF patients. Although it is usually associated with pancreatic sufficiency, all our patients were pancreatic insufficient.

The COVID-19 pandemic, through the restrictions and the non-pharmaceutical interventions implemented, has importantly impacted the circulation and epidemiology of respiratory viruses. Specifically, the 2020/21 season was entirely dominated by SARS-CoV-2, while influenza activity reached an all-time low, despite initial warnings that a double concurrent epidemic could be possible. The current season, 2021/22, started with the shift of circulating SARS-CoV-2 variants from delta to omicron, which then rapidly spread globally, as most countries, including Romania, removed all restrictions and compulsory non-pharmaceutical interventions. In this report we present the clinical reality observed in March 2022 in a tertiary paediatric hospital in Bucharest, Romania, where we observed a sudden surge in influenza cases, after two consecutive years (March 2020 to March 2022) when influenza had stopped circulating in our country. Thus, in March 2022 the positivity rate of rapid influenza antigen tests unexpectedly increased to 33.5%, paralleled by a decrease to 7.5% in the positivity rate of rapid SARS-CoV-2 antigen tests. This significant increase in the influenza attack rate was observed from the first week (14.9% positivity rate), through the fourth week of March (42.1% positivity rate, p < 0.001), while the COVID-19 attack rate displayed a significant decreasing trend (from 11.2% to 4.8%, p < 0.001). These data serve as a warning about relaxing restrictions in a precipitous approach with minimised vigilance. The evolution of these observations needs to be followed very carefully in all countries, particularly in settings where epidemiological interactions and non-pharmaceutical interventions have so far led to the extensive circulation of only one of these viruses, and we should now be prepared to perform a correct differential diagnosis between influenza and COVID-19, in order to ensure the best quality of care and personalized management of each case of respiratory infection. The results of active influenza surveillance studies for the whole 2021/22 season are awaited, in order to quantify the joint influenza—COVID-19 burden among children.

The COVID-19 pandemic has had a significant impact on the pediatric population, particularly on their access to health services. We conducted a retrospective study to assess the influence that the pandemic, and its related containment and mitigation public health measures, had on pediatric emergencies and hospitalizations in a major tertiary pediatric hospital in Bucharest, Romania, during the first six months of the pandemic, March–August 2020, compared to the same period in 2019. In these first 6 months of the COVID-19 pandemic, the number of pediatric emergencies decreased 2.8-fold compared to the same period in 2019, but the proportion of major emergencies increased significantly (p < 0.001). The number of admissions also decreased 3.3-fold in 2020, compared to 2019, but the risk of admission for lower respiratory tract infections and respiratory failure increased 1.3- and 2.3-fold, respectively. In conclusion, the restrictions imposed by the pandemic containment and mitigation plan not only had a significant impact on reducing emergency department presentations, but also on pediatric admissions in Romania. These data highlight the importance of maintaining optimal access to child health services when confronted with a public health threat, such as the COVID-19 pandemic. Active communication with parents, involving general practitioners, pediatricians, and authorities, is essential for managing children with acute signs of illness in the case of future restrictions or lockdown measures.

Vaccination is one of the most useful medical interventions for controlling certain infectious diseases. The aim of current research is to identify some of the drivers of vaccine hesitancy or acceptance in a rather skeptical European population by addressing parental perception on optional vaccination (OV) perception. Novel tools, delivered by social media, were used in our research attempt. A validated questionnaire was distributed online among parents. Parental knowledge, attitudes and perceptions of OV were analyzed. The majority of parent respondents (55.1%) showed very good knowledge about vaccination and vaccine-preventable diseases, and 76.0% stated that they had given at least one optional vaccine to at least one of their children. The most common optional vaccine administered was the rotavirus vaccine. The level of knowledge appeared to be related to compliance with OV. Concurrently, the rate of vaccine acceptance in the NIP (National Immunization Program) was not correlated with the level of parental knowledge. In total, a high percentage of parents (77.6%) believed that OV can bring an additional health safety benefit to their children. This study shows the need to involve the medical community in a steady dialogue with parents about OV. Raising awareness by presenting clear and understandable information could be a game-changing intervention in mitigating the public health impact of OV-preventable diseases.

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment.

Background and Objectives: Childhood obesity has been increasing at a worrisome pace and emerging as a non-infectious pandemic in the pediatric population in recent years. Raising awareness on this problem is of utmost importance, in order to take action to control body weight from an early age. Materials and Methods: We performed a retrospective study among overweight or obese children evaluated on an outpatient basis in the Department of Pediatric Endocrinology of a tertiary care hospital in Bucharest Romania in 2021 in order to identify laboratory changes occurring according to age and sex. Results: A total of 268 children were included in the analysis, with a median age of 10.9 years (IQR: 8.3, 13.3 years); 61.8% were obese and 38.2% overweight. We identified a subclinical pro-inflammatory status characterized by increased neutrophil count (12.7%) and increased C-reactive protein (16.4%). Biochemically, we identified the highest increases for uric acid (35.4%). More than half of the children included in the study had dyslipidemia-specific changes: high low-density lipoprotein cholesterol (LDL) (50.0%), low high-density lipoprotein cholesterol (HDL) (58.9%) and increased triglyceride levels (12.7%), especially children with a body mass-index (BMI) percentile above 95%. Increased thyroid stimulating hormone (TSH) was identified in 20.3% and low thyroxine (T4) level in 13.4%, especially in females. Conclusions: Early measures to control excess body weight are needed since preventing obesity is easier than treating it. However, this is often difficult to do in our country because parents frequently do not recognize the problem until it is advanced. Furthermore, doctors are not always adequately prepared and sometimes they do not have the support of the health systems to provide children in need with the adequate care. Educational strategies and awareness of issue should be revisited in current post-pandemic context that facilitates increase of obesity prevalence in children. Increase of efficient communication could be achieved by pointing to these objective findings.

Human adenovirus causes infections with a very heterogeneous clinical picture, and children are often the most frequently affected group. Interest in adenovirus has increased with the 2022 outbreak of severe acute hepatitis of unknown etiology as human adenovirus was considered as one of the possible etiological agents. We conducted a retrospective study over a 5-year period in two major tertiary hospitals in the Romanian capital with the aim to characterize the clinical picture and the dynamics of liver function tests in children with confirmed adenovirus infection. The study included 1416 children with a median age of 1.1 years (IQR: 0.3, 2.3 years). Digestive symptoms were predominant in 95.2% of children, mainly diarrhea (90.5%) and vomiting (50.5%), and 38.0% had respiratory symptoms. Increased transaminases were identified in 21.5% of patients. Age over 1 year, lethargy, vomiting and dehydration significantly increased the odds of liver cytolysis independent of other risk factors such as chronic conditions or co-infections. Aspartate aminotransferase (AST) was more commonly increased compared to alanine aminotransferase (ALT). Only six children had transaminase increases above 500 U/L, three of which had co-infections with rotavirus, Epstein–Barr virus (EBV), or respiratory syncytial virus (RSV). Liver function tests should be part of routine monitoring for pediatric patients with adenovirus infection. The current study fills a gap in current knowledge related to the frequency and the extent of liver involvement in human adenovirus infection among pediatric patients.

This review presents current updates of pancreatic enzyme replacement therapy in children with cystic fibrosis based on literature published in the last decade and some special considerations regarding pancreatic enzyme replacement therapy in the era of new therapies, such as cystic fibrosis transmembrane conductance regulator modulator therapies. Few articles evaluate the efficacy of pancreatic enzyme replacement therapy in the pediatric population, and most studies also included children and adults with cystic fibrosis. Approximately 85% of cystic fibrosis patients have exocrine pancreatic insufficiency and need pancreatic enzyme replacement therapy. Fecal elastase is the most commonly used diagnostic test for exocrine pancreatic insufficiency, although this value can fluctuate over time. While it is used as a diagnostic test, it cannot be used for monitoring the effectiveness of pancreatic enzyme replacement therapy and for adjusting doses. Pancreatic enzyme replacement therapy, the actual treatment for exocrine pancreatic insufficiency, is essential in children with cystic fibrosis to prevent malabsorption and malnutrition and needs to be urgently initiated. This therapy presents many considerations for physicians, patients, and their families, including types and timing of administration, dose monitoring, and therapy failures. Based on clinical trials, pancreatic enzyme replacement therapy is considered effective and well-tolerated in children with cystic fibrosis. An important key point in cystic fibrosis treatment is the recent hypothesis that cystic fibrosis transmembrane conductance regulator modulators could improve pancreatic function, further studies being essential. Pancreatic enzyme replacement therapy is addressed a complication of the disease (exocrine pancreatic insufficiency), while modulators target the defective cystic fibrosis transmembrane conductance regulator protein. Exocrine pancreatic insufficiency in cystic fibrosis remains an active area of research in this era of cystic fibrosis transmembrane conductance regulator modulator therapies. This new therapy could represent an example of personalized medicine in cystic fibrosis patients, with each class of modulators being addressed to patients with specific genetic mutations.

Introduction: The most common clinical manifestation of mango allergy is contact dermatitis, which can be localized or systemic. The sensitising substances that have long been suspected are alk(en)yl catechols and/or alk(en)yl resorcinols. Methods: We reviewed the original articles published on Pubmed, Embase and Cochrane Library before 15 September 2021, on the topic of contact allergy induced by mango and we synthesized the key data. Results: We found 12 case reports and four case series, with a total of 37 patients. Only seven of these cases were reported in patients from mango-cultivating countries, the other 30 were from countries where mango cultivation does not occur, and 26 were also from countries where poison ivy/oak are commonly found. We found that contact dermatitis may occur on the first exposure to mango due to previous sensitisation to urushiol-containing plants. The diagnosis was confirmed by patch testing in some of the cases. There was great heterogeneity between the reagents used. Conclusion: Mango fruit is frequently consumed, but mango induced contact dermatitis, the main hypersensitivity reaction induced by mango, is rare. Further data is necessary for a better understanding of sensitising substances and, consecutively, standardization of patch test reagents.

In a fast-paced medical reality, biosciences and bioengineering have become essential components in medical research and development. The aim of this paper is to characterize the recent progresses made in fighting antimicrobial resistance, particularly in relation to WHO’s priority pathogens, by providing an in-depth review of novel antimicrobials, drug delivery systems for targeted antimicrobial action and novel antivirulence targets. We systematically searched the ClinicalTrials.gov database to identify clinical trials targeting WHO’s priority 1 (critical) pathogens: carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant ESBL-producing Enterobacteriaceae. We identified a limited number of clinical trials, specifically for: one novel betalactamase inhibitor for Acinetobacter spp., one anti-virulence human monoclonal antibody for Pseudomonas spp. and no novel antimicrobials for carbapenem-resistant Enterobacteriaceae. We also performed a review of field literature to exemplify the main applications of drug delivery systems in infectious diseases, particularly in achieving targeted antibiotic distribution, in enhancing local activity with reduced off-target effects, triggered antibiotic release and triggered antibacterial photodynamic therapy. We conclude by presenting novel targets for antivirulence therapeutics that act by disrupting quorum sensing, inhibiting bacterial adherence and biofilm formation, silencing virulence traits and neutralizing bacterial toxins. Furthermore, the main principles of rational antimicrobial use are highlighted, in an effort to describe potential areas for targeted intervention, from diagnostic stewardship to antimicrobial stewardship.

Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident., This study reveals enormous differences in therapy with biologicals for childhood severe asthma across Europe, and demonstrates the urgent need for harmonisation in medication choice, definition of therapy success and how/when to discontinue treatment https://bit.ly/3tnJMTY

Introducere. Pneumonia comunitară este foarte frecventă şi este responsabilă de 16% dintre decesele la copiii cu vârstă de pană la 5 ani. Scopul prezentului studiu a fost să identifice potenţiali factori modificabili/influenţabili în legătură cu percepţia parentală privind managementul pneumoniei la copil. Conturarea unor astfel de factori ar permite elaborarea unor strategii de scădere a morbidităţii asociate pneumoniei în România. Materiale şi metode. A fost realizat un studiu transversal în perioada 25.08.2016 – 27.08.2016 ce a constat în distribuirea la nivelul platformelor de socializare a unui formular de tip Google Form pentru părinţii copiilor cu vârstă între 4 luni şi 5 ani. Chestionarul a cuprins 26 întrebări distribuite în 5 secţiuni. Colectarea datelor şi analiza statistică a fost realizată prin intermediul Microsoft Office Excel Worksheet. Rezultate. Au răspuns 1.083 de părinţi. La întrebarea privind statusul vaccinal am primit următoarele răspunsuri: 973 de copii sunt vaccinaţi (89.8%) conform Schemei Ministerului Sănătăţii şi 90 sunt vaccinaţi incomplet sau nevaccinaţi. 378 de copii au fost alimentaţi natural mai puţin de 4 luni sau niciodată. 32% (352) au diversificat la o vârstă mai mică de 4 luni şi 19% (201) după 6 luni. 46,91% (508) din copii au avut infecţii acute de căi respiratorii şi 42,41% (215) dintre aceştia au avut nevoie de internare. Pe primele două poziţii ale simptomelor care i-ar determina să se prezinte cu copilul la medic se află febra 47,83% (518) şi tusea 19,58% (212). 38,87% (421) dintre respondenţi au administrat medicamente fără a cere sfatul unui medic, iar 61,3% (358) din respondenţi administrat analgezice şi antipiretice. Pneumonia a fost recunoscută drept o boală gravă care poate determina uneori deces de către 69,07% (748) dintre respondenţi. Discuţii. Deoarece în literatură există dovezi ale unei corelaţii a morbidităţii şi mortalităţii în pneumonia copilului mic cu statusul socio-economic şi cu cel educaţional familial, am dorit să explorăm şi alţi factori potenţial incriminabili, în această epocă de semnificative modificări de percepţie parentală şi de comportament social sau de comunicare. Concluzii. Scăderea ratei de acoperire vaccinală în România (89% la acest grup selectat de pacienţi cu acces la Social Media) a dus la coborârea sub pragul la care se menţine imunitatea de grup. Părinţii din România care au răspuns la chestionar au obţinut un scor bun la recunoaşterea simptomelor şi aprecierea gravităţii pneumoniei. Numărul mare de respondenţi incluşi în studiu într-un timp scurt este un indicator al dorinţei părinţilor de a se informa. Această schimbare de comportament a noii generaţii de părinţi din ţara noastră ar putea genera alternative la strategiile educaţionale existente. Elaborarea unor surse Social Media de informaţii medicale în limba romană precum şi îndrumarea părinţilor către acestea ar putea duce la îmbunătăţirea calităţii informaţiilor deţinute de părinţi.

Introduction. Community acquired pneumonia is a common disease that accounts for 16% of all deaths in children aged 5 years or younger. The purpose of the study was to identify potential modifiable factors in relation with parental perception of pneumonia management in children. Outlining such factors would allow development of approaches in order to reduce pneumonia-associated morbidity. Methods. A cross-sectional study was conducted between 25th and 27th August 2016. It consisted in distributing a Google Form to parents of children aged between 4 months and 5 years via online social platforms. The questionnaire was structured in 5 sections with 26 questions. Data collection and statistical analysis were done using Microsoft Office Excel Worksheet. Results. 1083 parental answers were received and analyzed. Regarding vaccinal status we received following data: 973 (89.8%) children were vaccinated according to Romanian Ministry of Health Schedule and 90 children are incompletely vaccinated or unvaccinated. 378 children were never breastfed or exclusively breastfed for less than 4 months. 32% (352) were complementary fed before the age of 4 months and 19% (201) after 6 months. 46.91% (508) of children had experienced in the past Acute Respiratory Tract Infections and 42.41% (215) of them were admitted. The most frequent two symptoms that would cause parents to generate an unscheduled ED visit were fever [in 47.83% (518)] and cough [in 19.58% (212)]. 38.87% (421) of respondents gave their child medication without physician’s advice and 61.3% (358) used analgesics and antipyretics. Pneumonia has been recognized as a serious illness, potentially life threatening, by 69.07% (748) of parents. Discussion. There is evidence of correlation between morbidity and mortality in childhood pneumonia and parental educational and socio-economic status. Aim of our study was to explore other factors that impact parental perception, in this era of significant changes in social behavior and communication. Conclusion. The decrease in the vaccine coverage rate in Romania (89% in this group selected by patients with access to Social Media) led to a decrease below the threshold for maintaining herd immunity. Romanian parents responding to this questionnaire achieved a good score in symptom recognition and severity assessment of pneumonia. A large number of respondents surveyed in a short time is an indicator of parental desire to be informed and involved in decision-making. This recent change in parental behavior in our country could generate alternatives to existing educational strategies. Developing medical information platforms for Social Media, translated in local language, could impact parental perception and child pneumonia morbidity in our country.

Introduction: The most common clinical manifestation of mango allergy is contact dermatitis, which can be localized or systemic. The sensitising substances that have long been suspected are alk(en)yl catechols and/or alk(en)yl resorcinols. Methods: We reviewed the original articles published on Pubmed, Embase and Cochrane Library before 15 September 2021, on the topic of contact allergy induced by mango and we synthesized the key data. Results: We found 12 case reports and four case series, with a total of 37 patients. Only seven of these cases were reported in patients from mango-cultivating countries, the other 30 were from countries where mango cultivation does not occur, and 26 were also from countries where poison ivy/oak are commonly found. We found that contact dermatitis may occur on the first exposure to mango due to previous sensitisation to urushiol-containing plants. The diagnosis was confirmed by patch testing in some of the cases. There was great heterogeneity between the reagents used. Conclusion: Mango fruit is frequently consumed, but mango induced contact dermatitis, the main hypersensitivity reaction induced by mango, is rare. Further data is necessary for a better understanding of sensitising substances and, consecutively, standardization of patch test reagents.

Introducere şi scopul studiului. În ultimii ani, se înregistrează in România o creştere impresionantă a numărului de copii care beneficiază de administrarea medicaţiei pe cale inhalatorie. Acest fenomen a apărut în condiţiile modificării comportamentului general de informare, cu deplasarea centrului de greutate către mediul online. Autorii doresc să analizeze comportamentul actual al părinţilor şi medicilor români în ceea ce priveşte administrarea medicaţiei inhalatorii. Materiale şi metodă. Pentru prezentul studiu au fost utilizate două chestionare online distribuite într-un grup naţional reprezentativ de părinţi români (Spitalul Virtual de Copii), care are peste 60.000 de urmăritori. Rezultate. Chestionarele au avut peste 4.000 de respondenţi, atât părinţi, cât şi medici. 94,4% au confirmat utilizarea medicaţiei inhalatorii la copil. Particular este aspectul utilizării dexametazonei din fiola de uz injectabil pentru nebulizare umedă în 67,8% dintre cazuri. Iar 7% precizează că, deşi le-a fost recomandată dexametazona în scopul nebulizării, aceştia nu au utilizat-o. Concluzii. După ştiinţa autorilor, acesta este primul articol din România care se adresează utilizării off-label a dexametazonei sub forma nebulizată. Aproape toti copiii din Romania primesc medicaţie inhalatorie, iar calea nebulizării este percepută de părinţi ca un tratament de scurtă durată şi care poate utiliza aproape orice fel de soluţie fluidă. 75% dintre copiii români care au făcut nebulizări au primit recomandare medicală pentru administrarea off-label a dexametazonei.

Data on the various aspects of brucellosis in children living in southern Israel are missing.Our aim was to study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children19 years of age in southern Israel during 2005-2011.The study population included all patients hospitalized with a diagnosis of brucellosis, established according to a clinical presentation compatible with brucellosis+presence of Brucella bacteremia (BB).A total of 128 (50.8%) of 252 patients admitted with a diagnosis of brucellosis had BB (all with Brucella melitensis). All patients were of Muslim Bedouin ethnicity. The mean incidence of BB in southern Israel was 16 cases/100,000 Bedouin, with no significant changes during the study period. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in20% of the patients. The most frequent symptoms were arthralgia (61.7%), weakness (32.8%), gastrointestinal disturbances (27.3%), myalgia (25%), and headache (18.8%). The main clinical findings included monoarthritis (36.7%), hepatosplenomegaly (25%), lymphadenopathy (17.2%), heart murmur (11.7%), and skin rash (9.4%), respectively. Anemia, leukopenia, thrombocytopenia, and pancytopenia were reported in 17.6%, 29.6%, 12.8%, and 2.3% of the patients, respectively. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole; a total of 77 (60.2%) patients received gentamicin and doxycycline.Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in50% of the children with brucellosis, and B. melitensis was identified in all cases. Arthralgia, weakness, and gastrointestinal complaints were the most common symptoms, and monoarthritis, hepatosplenomegaly, and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in diagnosis of brucellosis.

Background and aim. In the last decade a significant increase of nebulized medication usage has been documented in Romania. Authors are aiming to describe parental and physician’s change of perspective regarding nebulized medication in the new era of online communication and education. Material and methods. Two different questionnaires were posted in a large and representative group (more than 60,000 followers) of Romanian parents and physicians, Virtual Children’s Hospital („Spitalul Virtual de Copii”). Results. More than 4,000 answers were submitted. 94.4% responders confirmed using at least once wetnebulized medication in children. A particular aspect documented was dexamethasone off-label usage via nebulizer in 67.8% children. Additional 7% of responders confirmed that they received an indication to nebulize a normal saline suspension with dexamethasone phosphate for parenteral usage, but they didn’t follow the indication and used an approved treatment. Conclusions. Upon our knowledge this is the first large study on nebulized dexamethasone in Romanian literature. 95% of Romanian children receive nebulized medication. Nebulizer is regarded by parents as a simple and friendly tool that can solve virtually all issues related to airway diseases in our country. 75% of children that received nebulized medication had a prescription for off-label use of dexamethasone.

Background and aim Inner-city paediatric asthma patients experience a significant increase of unscheduled and emergency department visits if they are not included in a continuous monitoring and educational program. Parental education represents a corner-stone of complex approach in these patients. The aim of our study was to document outcome of a structured parental involvement in management of asthmatic children. Material and methods Prospective 6 month survey of patients with persistent asthma previously included in tele-monitoring study of our clinic. Were included children with uncontrolled asthma [ACT child score below 19] and frequent visits in Emergency Department in 2014. Both parents and children were educated in basic inhalation technique [video-training], received a written-action plan (WAP) and a link to “Virtual Asthma Hospital”. They were provided as a rescue-option an ED unscheduled visit. Non-responders to WAP were presented in ED. Results In 2016 were 1078 ED visits of 326 patients with asthma. 34 children were included in study [10.43%] – 16 in monitoring group and 18 as controls. Patients had similar demographics [average age 6.6 years] and had male predominance [62.8% vs 65.1% in controls]. 2 in education vs 10 children in control group had one or more unscheduled visits to ED during study. Odds-ratio to have an unscheduled ED visit was 0.1143 in study group [p 0.0151, 95% CI 0.0199–0.6571]. All parents in intervention group were able to demonstrate an efficient inhalation technique. Inhaled steroids (ICS) compliance was significantly better in education group (87.5% vs 38.8%) Conclusion Social media education can decrease the burden of unscheduled ED visits and increase ICS compliance for asthmatic children, in low-resource settings.

Background and aims Current recommendation in managing CF patients regarding Vitamin D status ( 2005 European Consensus) are annually Vitamin D, Calcium and electrolytes identifications with prompt therapeutic intervention. Methods 1 year retrospective Study with 68 children included (29 girls and 39 boys ) in which annual determination of Vitamin D was conducted. All children between 1 year and 18 years were included, with a medium age of 7.9 years. In patients with significant vitamin D deficiency identified treatment with high Vitamin D daily dose was established (btw. 2000-4000UI/d) and 6 Months close monitoring was conducted. results: In 15% severe Vitamin D deficiency was identified ( Conclusions Vitamin D deficiency is frequent among cystic fibrosis patients, 15% of them having severe deficiency. Recovering the deficit should include, besides Vitamin D supplementing, interventions on all the other factors involved in absorption of Vitamin D in cystic fibrosis children.

Background Cystic fibrosis (CF) is a complex disorder with multisystem involvement. Although we used to believe that an association between CF and food allergies is rare and more frequently a false diagnostic, in the late years, as food allergies’ prevalence is rising, the association between these two disorders is becoming more common. Aim the aim of the study was to determine food allergy prevalence in cystic fibrosis patients treated at the Mother and Child Care Institute ‘Alessandrescu-Rusescu’ between 2011–2016. Method we conducted a five years retrospective study between 2011–2016 on 68 cystic fibrosis patients. Age of CF diagnostic was between 2 months and 10 years. We followed the cases with poor nutritional status despite PERT and proton pump inhibitors therapy and the association with cutaneous manifestations. We performed allergen specific IgE antibody test (lactalbumin, casein, beta lactoglobulin, egg, carrot, soya, nut, peanut, wheat, bovine serum albumin). Results 8 out of 68 CF patients treated in our centre had food allergies, with a 11,76% prevalence. 6 of them have milk protein allergy, 1 with egg white allergy and 1 patient with multiple allergies (milk protein, egg, wheat, peanuts). Conclusion it is important to further investigate possible comorbidities in CF patients with poor nutritional status and persistent digestive symptomatology despite adequate nutrition and adherence to PERT therapy. Food allergies seem to be one of the most frequent associations, surpassing celiac disease. Treatment conduct and nutritional recovery in these cases represent a milestone even for experienced clinicians.

Background in cystic fibrosis (CF), the number of pulmonary exacerbations and their severity determine the lung function decline. Prevention of pulmonary exacerbations and thier early diagnosis slows down the progression of pulmonary disease and of lung function decline, improving both quality of life and life expectancy in CF paediatric patients. Aim the aim of the study was to evaluate predisposable factors associated with pulmonary exacerbations in cystic fibrosis patients at Mother and Child Care Institute „Alessandrescu Rusescu’ between 2013–1016. Method we conducted a four years retrospective study, between 2013–2016 on 68 CF patients. We followed for each patient: the number of exacerbations that required admission, number of admissions per year, time period between exacerbations, lung function, pulmonary infectious status. Results 68 patients were included, with a male predominance (39 boys, 29 girls). Age repartition: 19 patients aged between 1–5 years old, 34 patients aged between 6–11 years old, 15 patients aged between 12–18 years old. 15 patients (22%) had chronic Pseudomonas aeruginosa (PA) infection. 17 patients (25%) were admitted for moderate/severe pulmonary exacerbations, 4 of them having a time period less than 3 months between exacerbations. For these last 4 patients the infectious status was: 2 with PA, 1 with MRSA, 1 with MRSA, PA and Burkholderia caepacia. Lung function decline in admitted patients for pulmonary exacerbations: 16% -more than 15% drop in FEV1, 38% 5%–10% drop in FEV1, the rest of them with a mild drop in FEV 1 (less than 5%). Treatment duration was between 10–21 days with a median of 14 days for 64% of them. Only 2 of these 17 patients had a normal nutritional status. Conclusions predisposable factors for CF pulmonary exacerbations that require admission seem to be: poor nutritional status, incomplete cure of PA first determination, low treatment adherence, polymicrobial pulmonary infections.

Video Recordings are very useful in the clinical practice. Most times physicians should diagnose their patients based on descriptions coming from parents or other family members that are emotionally involved. It is very difficult to differentiate some entities in this circumstances. This is why many times there are patients who receive unnecessary treatment or, on the contrary, are deprived of useful remedies. The presenter aims a practical and interactive discussion based on videos and case presentations underlying the role of home video and of video-EEG recording methods. Different non-epileptic and epileptic events will be presented and key recognition issues will be underlined.

Backgroud and Aim Antibiotics have produced an estimated increase of life-expectancy of 2 to 10 years. Due to irrational use of antibiotics, bacteria gained multi-resistance. 23.000 patients die each year in US due to infections with resistant bacteria. The aim of our paper is to describe controllable mechanisms of antibiotic excessive prescription for acute gastroenteritis (AGE) in a tertiary referral paediatric hospital. Material and Methods Five months prospective study regarding all ICD 10 A00-A09 (Intestinal infectious diseases) discharged patients and a subgroup of outpatients treated in Emergency Department. Children up to 5 years with no significant comorbid conditions or immune-deficiency were included. Parents of ED-treated children received a questionnaire to evaluate before discharge a subset of expectancies related to hospital care. Results 250 [191 inpatients and 59 outpatients] were included and 211 [84.4%] had a documented cause for acute gastroenteritis. 42.8% rotavirus and 18.4% Campylobacter cases were diagnosed. 24.4% presented multiple etiologies, roto-adenovirus representing the most frequent in 29.5% of coinfections. More than half (51.5%) of virus-induced AGE were treated with antibiotics. Discussions Subgroup analysis was performed and a pattern of prescription was described. Inpatients, infants, children with more severe dehydration [CDS above 4], those presented during weekend and parental expectation for antibiotic treatment were risk-factors for inappropriate antibiotic prescription. There were significant fewer antibiotic prescriptions in ED-treated patients compared with inpatients of similar severity or age group. Conclusion Antibiotic stewardship programs should be implemented and behaviour patterns, both of parents and physicians, should be changed in order to decrease antibiotic-overuse in children.

Background and aims Cystic Fibrosis represents the most frequent monogenic autosomal recessive disease in Caucasians. Among multiple systemic determination, the pancreatic function is affected, with primordial exocrine dysfunction and second endocrine disorder. Acute pancreatitis is a rare complication in CF, rapid diagnosis allowing selection of patients for closer monitoring for recurrent events. Method 5 year retrospective study, conducted in INSMC ‘Alessandrescu Rusescu’, Bucharest. All charts of our CF patients were revised and 48 patients aged>3 years were included. Acute clinical manifestation like : violent abdominal pain and vomiting associated with high amylase levels above 170ui/L, serum glucose, ALT, AST and BMI. Results 3 patients were diagnosed with acute pancreatitis, with a frequency of 6,25%. None of the patients associated high glucose serum levels nor high AST or ALT. BMI was 17,3–18,07 kg/m 2 . One patient presented a recurrent event during the 5 year study. In 2 patients we found low compliance for PERT and in 1 patient Campylobacter Pylori acute gastroenteritis was associated. Conclusions We identified a higher frequency of acute pancreatitis among our patients ( 6,25% compared with 3,5% described in general population) possibly determined by low treatment compliance ( PERT and nutritional recommendation) and associated with digestive illnesses.

75-80% of life threatening situations, with unexpected arrest, are documented out of hospital (1). This situation generates frequently a diffi cult resuscitation. Main cause for failure is delay in gaining vascular access for fl uid and drug delivery (2). Intraosseous access (IO) is used for treatment in patients without a previously placed intravenous line that experience abrupt-onset life threatening situations (3). Authors revisit data from initial development of this method and document the role of IO access as a valuable tool during resuscitation according to European Resuscitation Council Guidelines 2010 (4). Particular aspects of technique, improvisations and real life trouble shooting issues are presented from a single pediatric Emergency Department experience.

75-80% dintre situaţiile ameninţătoare de viaţă, cu stop cardio-respirator neaşteptat, se petrec în afara spitalului (1). De aceea este întâlnită frecvent situaţia unei resuscitări difi cile. Principala cauză de eşec este obţinerea tardivă a unei căi de acces vascular pentru administrarea fl uidelor şi medicaţiei necesare în aceste situaţii (2). Abordul intraosos este folosit în tratamentul pacienţilor afl aţi în situaţii ameninţătoare de viaţă şi care nu au alt acces vascular instalat anterior (3). Lucrarea de faţă trece în revistă aspecte ale dezvoltării acestei tehnici de acces vascular rapid şi aplicaţiile ei actuale în medicina de urgenţă, prin prisma noilor ghiduri de resuscitare la copil, apărute sub egida European Resuscitation Council (4).

Purposes and objectives. Bronchial asthma is the most frequent chronic disease in children and in almost 50% of these cases, it occurs eosinophilic airway infl ammation. The most important objective in monitoring asthma is preventing exacerbations by means of good communication between phisician, patient and family, a good compliance of the latter and an accurate assesment of the asthmatic patient’s quality of life. Present study is examining correlation between asthma control and airways eosinophilic infl ammation level in asthmatic children treated with ICS. Method and material. We evaluated 24 patients presented in emergengy department of our hospital, during ten weeks in cold season. The assesment consisted in performing Asthma Control Test (ACT), measuring fraction of the exhaled nitric oxide (FeNO) and pulmonary function testing. Results and discussions. We documented a negative linear correlation of ACT score with FeNO (r = -0. 6286 (p < 0.01)). Conclusions. Measuring FeNO is a simple to perform, fast and noninvasive method. FeNO value is related to ACT score, between them being a negative linear correlation. Generating simple algorithms may improve control of disease and tailoring therapy asthmatic children.

Scopuri şi obiective. Astmul bronşic este cea mai frecventă boală cronică la copii. În peste 50% din cazurile pediatrice, infl amaţia căilor aeriene este eozinofi lică. În monitorizarea astmului, cel mai important aspect este prevenirea exacerbărilor printr-o bună comunicare medic-pacient-familie şi o complianţă ridicată a acestora din urmă la tratament. Foarte importantă este şi evaluarea corectă a calităţii vieţii copilului cu astm. Studiul de faţă şi-a propus verifi carea corelaţiei între nivelul de control al astmului şi nivelul de infl amaţie eozinofi lică de la nivelul căilor aeriene la copiii afl aţi în tratament cu corticosteroizi inhalatorii (CSI). Material şi metodă. Am evaluat un număr de 24 pacienţi care s-au prezentat la compartimentul de primiri urgenţe al spitalului IOMC „Alfred Rusescu“ Bucureşti în cursul a zece săptămâni din anotimpul rece. Evaluarea a constat în efectuarea scorului Asthma Control Test (ACT), măsurarea fracţiei de Oxid Nitric din aerul expirat (FeNO) şi probe funcţionale respiratorii. Rezultate şi discuţii. Valoarea scorului ACT în funcţie de măsurarea FENO arată o corelaţie liniară şi negativă cu r = -0.6286 (p < 0,01). Concluzii. Măsurarea FeNO este o metodă simplă, rapidă şi neinvazivă. Valoarea FeNO este corelată cu scorul ACT, în mod liniar şi negativ. Crearea unor algoritmi simpli ar putea îmbunătăţi controlul şi monitorizarea evoluţiei şi ar permite personalizarea terapiei la copilul cu astm.

Boala diareică acută (BDA) reprezintă o cauză frecventă de morbiditate la toate grupele de vârstă şi a treia cauză de mortalitate, la copilul sub 5 ani, după decesele perinatale şi afecţiunile respiratorii. Copiii, în special cei cu vârstă mică, sunt deseori afectaţi de forme severe de BDA, principalul mecanism generator de complicaţii cu risc letal fi ind deshidratarea acută. Articolul de faţă doreşte a fi o punere la punct a celor mai noi recomandări de evaluare şi de tratament în deshidratările acute la copil. Este subliniat rolul evaluării semnelor precoce de şoc, precum şi al semnelor de mare gravitate, folosind algoritmii European Resuscitation Council şi criteriile Pediatric Advanced Life Support. Sunt date exemple practice de evaluare şi de tratament, fi ind detaliate opţiunile de rehidratare în funcţie de severitate şi comorbidităţi.

Este descris cazul unui pacient în vârstă de 15 luni, internat pentru infecţii repetate şi prelungite, asociate cu afectare neurologică progresivă. Evaluarea imunologică a detectat nivele serice scăzute ale imunoglobulinelor şi populaţii de limfocite T şi B reduse, cu un fenotip T-B-NK+. Imagistica a arătat lipsa timusului şi atrofie corticală cerebrală. Elementul cheie care a orientat diagnosticul a fost determinarea acidului uric seric: hipouricemia a sugerat deficit de purin nucleozid fosforilază, o boală foarte rară, cu doar 67 de cazuri raportate la nivel mondial. Diagnosticul a fost confirmat de măsurarea activităţii enzimatice printr-o metodă radioizotopică.

Background and Aim: In limited-resource settings pediatric asthma patients experience a significant increase of unscheduled and emergency department visits. Parents can be involved in the complex effort of treatment and management. The aim of our study was to document outcome of a structured parental involvement in management of asthmatic children. Material and Methods: Prospective 12 months study of patients with persistent asthma. Were included children with uncontrolled asthma [ACT child score below 19] and frequent visits in Emergency Department in previous year. Both parents and children were educated in basic inhalation technique [video-training] and were provided a written-action plan. A sub-group were trained to use PIS [Pulmonary Index Score] to evaluate severity of exacerbation and treatment response. They were provided as a rescue-option before an ED unscheduled visit the option to be tele-monitored by a specialist. Short video of clinical status was evaluated by an expert and further options were discussed. Non-responders were presented in ED. Results: In 2014 were 880 ED visits of 296 patients. 54 children were included in study [18.2%] – 16 in monitoring group and 38 as controls. Patients had similar demographics [average age 5.6 years] and had male predominance [68.8% vs 71.1% in controls]. 2 vs 16 children in control group had more than 1 visit to ED in 2014. Odds-ratio to have an unscheduled ED visit was 0.1964 in tele-monitoring group [p 0.0483, 95% CI 0.039 – 0.9881]. Conclusion: Tele-monitoring and simple clinical scoring systems can decrease the burden of unscheduled ED visits for asthmatic children, in low-resource settings.

We report the case of a male patient with a normal development in the first three months of life, presenting for global regression, central axial hypotonic syndrome, pyramidal syndrome, focal epileptic seizures, and a particular aspect of the hair - almost absent, short, sparse, lightly colored, at age of five months, becoming coarse, twisted (kinky hair) by the age of 21 months. Different diseases associate similar neurological and macroscopic aspect of the hair (biotinidase deficiency, argininosuccinic aciduria, aminoaciduria, giant axonal neuropathy, trichothiodistrophy and Menkes syndrome). The microscopic aspect of the patient’s hair showing normal hair, silver colored hair, hair shafts twisting 180(°), trichoclasis, and trichoptilosis, was highly characteristic for Menkes disease. Diagnosis was further supported by the low concentration of serum copper and ceruloplasmin and exclusion of other metabolic disorders with similar macroscopic aspect of the hair. Molecular genetic testing by multiplex PCR indicated deletion of exon 22 in the ATP7A gene situated in Xq21.1 region, consistent with the clinical and biochemical phenotype. Physicians should use microscopic evaluation of the hair more often when suspicion of Menkes disease is raised, aiming a narrow further diagnostic workup and early positive diagnosis and genetic advice for the affected families.

Background We present clinical and molecular findings of a patient with ceroid-lipofuscinosis CLN7, with a compound heterozygous mutation of the MFSD8 gene, with Rett syndrome clinical signs onset and a later development of full picture of vLINCL. Case presentation A 7 years-old female patient with normal development until the age 12 months, developed Rett like clinical picture (psychomotor regression, microcephaly, stereotypic hands movements in the midline, hyperventilation episodes) present at the onset of her condition (age 18 months), features still present at the initial evaluation in our clinic at age 5 years. Results MECP2 (methyl CpG binding protein 2) gene mutation was negative. At age 6 years she was readmitted for severe ataxia and blindness, seizures, and severe developmental regression leading to NCL (neuronal ceroid lipofuscinosis) suspicion. EEG showed slow background with IRDA (intermittent rhythmic delta activity). A conjunctive biopsy showed abnormal curvilinear and fingerprint lysosomal deposits, and genetic analysis revealed two heterozygous mutations of MFSD8 gene (c.881C > A p.Thr294Lys and c.754 + 2T > A) each inherited from carrier parents and a heterozygous variant (c.470A>C p.Asp157Ala) of CLN5 gene. Conclusion NCL should be suspected and MFSD8 genetic testing should also be considered in patients with Rett like phenotype at onset and negative MECP2 mutation. Such cases should be carefully and frequently re-evaluated in order to avoid delayed diagnosis and offer proper genetic advice to the family. In our knowledge, this might be the first case of CLN7 disease with Rett like onset described in the literature, which developed typical vLINCL clinical phenotype after age 5.5 years. A short review of the literature showing NCL onset modalities is presented.

Cystic fibrosis ormucoviscidosis (CF) is the most frequent monogenic genetic disease with autosomal dominant transmision in caucasians. Currently, the typical approach is referring the CF patient to specialized centers with multidisciplinary teams. The inherent questions appear: which is then the role of the general practitioner (GP)? Should the GP be confined to the pasive role of exchanging medical letters with the specialist, or should he take active part in monitoring the disease? Is it ethicallyand professionally correct for the GP to simply copy the treatment of a patient that hedidn't actually see for years, or to assume the palliative care in final stages of a patient who was actually taken care of only by the specialist? What are the families' expectations and what is the level of competence they expect from the GP? These are some of the questions we will try to answer, considering the expertise we accumulated in the regional center in "Alfred Rusescu" lnstitute for Protection of Mother and Child, where 16.22% (60 out of 370) of CF patients in Romania are monitored, and based on a questionnaire addressed to the CF patient's families.

Asthma is the most frequent chronic disease of childhood. In spite of significant improvement of treatment options and diagnostic tools, asthma remains in many patients uncontrolled. The term of "severe asthma" seems to be rather a large umbrella for a heterogeneous group of diseases. This paper is presenting our experience in two respiratory disease clinics that evaluate asthmatic children. Current study was designed to test an algorithm for daily practice in a special group of patients: children with previously diagnosed asthma or recurrent-wheezing, evaluated by family physician or pediatrician as severe disease ("Asthma Decalogue in Children"). Out of 313 referrals (during a six months inclusion time) we had 202 children completing study per-protocol. 49 (22.69%) had severe disease, but only 8 had severe asthma (3.7% of total patients and 18.6% of severe patients). They were older, with less male predominance and with more frequent rhino-conjunctivitis and D vitamin deficiency than other asthmatic children with less severe disease. Asthma Decalogue in Children seems to be an efficient tool to differentiate severe asthma from the rest of children with reactive airway diseases.

Background Little is known about the incidence and dynamics of occult bacteremia (OB) among infants/young children following the introduction of pneumococcal conjugate vaccines (PCVs) into the national immunization program in Israel in 2009–2010. The aim of this study was to characterize the epidemiologic and microbiologic picture of OB among febrile infants/children aged 3–36 months in southern Israel, before and after PCVs introduction. Methods Retrospective study enrolling all infants/young children attending the emergency room of a tertiary medical center in southern Israel with fever without source, discharged, and reported with a positive blood culture. Results Of 453 true bacteremias, 89 (19.6%) were defined as OB. OB rate was 0.22%; a significant decrease was recorded in OB rates, with the highest rate during 2005 (0.34%) and the lowest during 2011 (0.15%). OB cases decreased in post-PCV (2010–2012) versus prevaccination period (2005–2009) from 66/22,256 cases (0.3%) to 23/13,213 cases (0.17%; p = 0.03). Most frequent single OB pathogens were Streptococcus pneumoniae, Streptococcus viridans spp., and Kingella kingae (39.3%, 10.1%, and 9.0%, respectively); Enterobacteriaceae spp. were isolated in 10 cases (11.2%). No changes were recorded in S. pneumoniae-OB cases; K. kingae-OB decreased significantly (p = 0.047). None of the S. pneumoniae serotypes isolated during 2011–2012 belonged to 13-valent PCV (PCV13). An increase in non PCV13 serotypes was recorded during 2011–2012 (3/3, 100% vs. 7/32, 21.9%, p = 0.01). Conclusion OB rates decreased significantly following the introduction of PCVs. S. pneumoniae was the most frequent isolated pathogen in OB, but in lower percentages compared with the medical literature. No PCV13 serotypes were detected as a cause of OB during 2011–2012.