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Background: To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods: A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results: Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions: The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC). [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) associated with COVID-19 in children is not well described in the literature, so this study was designed to assess the severity, clinical course, different treatment measures, and outcome of this group of patients. Patients and methods: This descriptive study was performed by retrospective chart review of children admitted in pediatric intensive care unit (PICU) in the age-group of 1 month to 12 years over the period of 6 months (July--December 2020) in a tertiary care pediatric COVID facility in eastern India. Severity of ARDS, ventilator settings, oxygenation and laboratory parameters, and outcomes were documented. Predictors associated with severe ARDS were evaluated. Results: Among 128 laboratory-confirmed pediatric COVID-19 cases admitted in PICU, 18 (14%) developed ARDS, 6 (33.3%) had severe ARDS, and 3 (16.6%) succumbed to death. Outcome was measured by median hospital stay [20 days (IQR 19, 21)], PICU stay [13 days (IQR 10, 16)], and 28-day ventilator-free days [14 days (IQR 13, 22)]. Half (n = 9) of our study cohort had different comorbidities and congenital heart disease being the most common (4, 22.2%). Median positive end-expiratory pressure requirement was 10 cm H2O (9, 11) for invasively ventilated children (n = 13, 72.2%) along with peak inspiratory pressure of 24 cm H2O (20, 29) and mean airway pressure of 17 cm H2O (14, 20). Median oxygenation index was 13.3 (10.5, 18.6). Nine (69.2%) out of 13 intubated children had undergone prone ventilation. C-reactive protein (CRP) and D-dimer levels were significantly high in children with severe ARDS alongside pSOFA and lung USG score. Conclusion: Incidence of ARDS in pediatric COVID-19 though less but is not rare. Elevated CRP, D-dimer values, and high lung USG scores were associated with severe ARDS. Those who died had significant comorbidity. [ABSTRACT FROM AUTHOR]

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic. Materials and methods: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India. Results: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity. Conclusion: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C. [ABSTRACT FROM AUTHOR]