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Background: Data on infections in children are scarce in the context of earthquakes. Here, we describe our clinical experiences regarding infections in pediatric victims after the earthquakes in Kahramanmaraş/Türkiye., Methods: Trauma patients after the Kahramanmaraş earthquakes, aged under 18 years and admitted to our hospital, were evaluated retrospectively. The patients' demographic data, pathogen distribution, drug resistance, and antibiotic treatments were analyzed., Results: Thirty pediatric patients were admitted to our hospital from disaster areas. The median duration under the rubble of patients was 24 h (range: 0.3-120 h). The median time for these patients to arrive our hospital was 5 days (range: 2-18 h). All of them had wound infections, 3.3% of patients had both wound infection and urinary tract infection, and 13.3% had both a bloodstream infection and a wound infection. Seventy-nine positive cultures were detected in repeated samples of 19 patients, of which polymicrobial infections accounted for 50.6% and monomicrobial infections constituted 49.4%. Of these, 107 were Gram-negative bacilli (79.9%), and 27 were Gram-positive cocci (20.1%). Pan-drug-resistant (PDR) and extensively drug-resistant (XDR) possible PDR bacteria constituted 73.6% of total Gram-negative bacteria. Carbapenem-based treatments (n = 14, 46.7%) were the commonly preferred antimicrobial regimen. Fasciotomy was performed in 53.3% of the patients (n = 16) and amputation in 30% of the patients (n= 9). All of our patients survived., Conclusion: Factors that reduced mortality and morbidity in the earthquake victims were broad-spectrum antibiotic therapy targeting highly resistant bacteria, and complementary surgical management. In other words, the multidisciplinary approaches of pediatricians and surgical departments were life saving after the earthquake., (© 2024 Japan Pediatric Society.)

Background: This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia, for which effective treatment is still lacking with respect to this population., Methods: We conducted a retrospective study and included patients (aged < 18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2-4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and compared the side effects of different MPZ doses and patient survival., Results: Fifty-nine patients were included: 61% were male, the median age was 8, interquartile range (IQR) 2-15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data did not differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group., Conclusion: The patients with high-dose MPZ had better clinical and radiological responses than those with standard-dose MPZ, although the mortality rate did not differ between standard and high-dose regimens of MPZ., (© 2023 Japan Pediatric Society.)

Background: Influenza in children has been well described, whereas there has been a paucity of pediatric data regarding COVID-19. It is crucial for clinicians to differentiate cases of COVID-19 from cases of influenza because of the upcoming influenza season in the new pandemic era., Methods: This retrospective study included pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March and September 2020, or seasonal influenza between October 2019 and March 2020., Results: A total of 315 children were included in this study; 151 were diagnosed with influenza and 164 had confirmed COVID-19. The median age of patients with COVID-19 was 10 years (interquartile range [IQR]: 3-15 years), whereas the median age of patients with influenza was 4 years (IQR: 1-6 years) (p = 0.001). In the COVID-19 group, 6.3% of patients had underlying diseases, the most frequent being neurological conditions (3%). In the influenza group, 20.9% of patients had an underlying disease, the most frequent being asthma (14.5%). Fever (odds ratio [OR]: 20.476; 95% confidence interval [CI]: 2.438-171.995; p = 0.005), dyspnea/tachypnea (OR 13.950; 95% CI: 2.607-74.634; p = 0.002), and increased C-reactive protein (CRP) (OR: 7.650; 95% CI: 2.094-27.955; p = 0.002) were main predictors of influenza diagnosis in comparison to COVID-19. Lymphopenia was detected in 43.2% of patients with influenza and 19.9% of patients with COVID-19 (p = 0.001)., Conclusions: The accurate differentiation between "influenza or COVID-19" seems possible by evaluating a combination of factors including cough, fever, vomiting, leucopenia, lymphopenia, pneumonia, in pediatric patients with high CRP as well as age., (© 2023 Japan Pediatric Society.)