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Objective: To determine the prevalence of COVID‐19 in a cohort of children undergoing tonsillectomy through assessment of B cell immune responses to SARS‐CoV‐2 in both peripheral blood and tonsil tissue. Methods: In this cohort study at a tertiary pediatric hospital (Children's National Hospital) in Washington, DC, we recruited 100 children undergoing tonsillectomy from late September 2020 to January 2021. Serum, peripheral blood cells, and tonsil tissue were collected and examined for immune reactivity to SARS‐CoV‐2. Parent‐reported clinical histories were compared to antibody and B‐cell responses. Results: Among 100 children undergoing tonsillectomy, 19% had evidence of immune responses to SARS‐CoV‐2 (CoV2+), indicating prior COVID‐19. In all seropositive participants, we detected SARS‐CoV‐2 specific B cells in both peripheral blood mononuclear cells and tonsils, providing evidence for tissue‐specific immunity in these children. Of the 19, 63% reported no known history of COVID‐19, and an additional 3 were asymptomatic or unaware of an acute infection when detected on pre‐surgery screen. Hispanic children represented 74% of CoV2+ subjects compared to 37% of the full cohort. 100% of CoV2+ children lived in a zip code with poverty level >10%. Conclusions: Nearly one‐fifth of children undergoing tonsillectomy at an urban U.S. hospital had evidence of prior COVID‐19 during the early pandemic, with the majority unaware of prior infection. Our results underscore the ethnic and socio‐economic disparities of COVID‐19. We found concordant evidence of humoral immune responses in children in both blood and tonsil tissue, providing evidence of local immune responses in the upper respiratory tract. Level of Evidence: 3 Laryngoscope, 133:1993–1999, 2023 [ABSTRACT FROM AUTHOR]

Background: Resuscitation with blood products is often required for pediatric cardiac surgery patients following cardiopulmonary bypass. However, data suggest that blood product transfusion is an independent predictor of adverse outcomes. Most studies have specifically found detrimental effects of overall transfusion of red blood cells in particular, but few have analyzed outcomes by the other specific blood product components. Aims: The objective of this study is to analyze adverse outcomes associated with intraoperative transfusion of specific blood product components. Methods: A retrospective review was performed on 643 pediatric patients who underwent cardiac surgery requiring cardiopulmonary bypass to evaluate the risk of selected adverse outcomes associated with intraoperative blood product transfusion. Adverse outcomes included thrombotic complications, stroke, acute kidney injury, prolonged mechanical ventilation, and death. Univariate logistic and linear regression analyses were performed to explore the association between various blood products and the occurrence of postoperative complications. Multiple logistic and linear regression analyses were performed adjusting for age, cyanotic status, The Society of Thoracic Surgeons‐European Association for Cardio‐Thoracic Surgery Score (STAT score), and cardiopulmonary bypass time. Results: Unadjusted analysis using univariate logistic and linear regressions showed statistically significant associations of almost all blood components (per 10 mL/kg dose increments) with multiple postoperative complications, including mortality, thrombotic complications, stroke, and days of mechanical ventilation. After adjusting for patient age, cyanotic status, STAT score, and cardiopulmonary bypass time, multivariable logistic and linear regression analyses revealed no association between transfusion of blood products with acute kidney injury and stroke. Administration of red blood cells was the only category significantly correlated with increased days of mechanical ventilation (0.5 days increase in mechanical ventilation per 10 mL/kg transfusion of red blood cells). The only blood product to show complete lack of a statistically significant association with any of the studied outcomes was cryoprecipitate. Conclusions: Transfusion of blood products following cardiopulmonary bypass is associated with postoperative adverse outcomes. Future studies aimed at strategies to reduce intraoperative bleeding and decrease the amount of blood products administered are warranted. [ABSTRACT FROM AUTHOR]

Background: Pediatric intestinal pseudo‐obstruction is a rare disorder affecting gastrointestinal motility leading to chronic symptoms and hospitalizations. There is limited understanding of the epidemiology and healthcare burden. Methods: We analyzed data from Kids' Inpatient Database from 2016, which includes inpatient discharge records from US hospitals. ICD‐10 codes were used to identify patients 0‐18 years with pediatric intestinal pseudo‐obstruction and comorbid conditions. Multivariable logistic regression and Wilcoxon rank‐sum test were used. Results: In 2016, there were 1671 inpatient discharges from US hospitals for patients 0‐18 years of age with this diagnosis. The incidence of inpatient admission was 29/100 000 patients. After controlling for age, race, income status, and insurance, males vs females (adjusted odds ratio, aOR: 1.10; 95% CI: 0.94‐1.28; P =.241) and caucasians vs other races (aOR: 1.55; 95% CI: 1.27‐1.88; P <.001) were more likely to be admitted. Inpatient admissions incurred significant healthcare burden; median (inter quartile range IQR) cost of hospitalization of US$ 52 079 (US$ 23 530‐120 961) and a median (IQR) length of stay of 6 days (3‐14 days). Gastrostomy (32%) and ileostomy (12.6%) status appeared to incur lower healthcare burden. Parenteral nutrition, malnutrition, and central line/bloodstream infections resulted in higher healthcare burden. Conclusions: Pediatric intestinal pseudo‐obstruction is a rare diagnosis with a high incidence of inpatient admissions and healthcare burden. An aggressive multidisciplinary management is crucial in reducing inpatient admissions in this cohort. [ABSTRACT FROM AUTHOR]