Search

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 outbreak that has spread all around the world is still a threat for humankind. Epidemiological, clinical, laboratory, and radiological features of the disease are enlightened day by day. It was aimed to evaluate the characteristics of children and their parents with COVID-19 to aid in diagnosis and treatment. Material and Methods: A retrospective review of the medical records of pediatric patients and their parents who were confirmed as COVID-19 positive, between April 23, and May 28, 2020, was conducted. Results: A total of 93 children and 81 adults were evaluated in the present study. Asymptomatic and mild cases accounted for 63.5% of the children and 50% of the parents. Of the children, 3.2% had moderate illness, whereas this was 9.8% for the parents There was a statistically significant difference in terms of the severity of illness between the children and their parents (p =0.01). Although it had a milder clinical course in children, one child died. Increased levels of C-reactive protein (CRP) were observed in 8.6% of the children and 48.1% of the patients, and there was statistically significant difference in terms of CRP levels between the children and their parents (p =0.001). Conclusion: The clinical, laboratory, and radiological features of COVID-19 showed differences in the children and their parents. It should be kept in mind that COVID-19 can be fatal in children, although the course of the disease appears to be milder in children than in their parents [ABSTRACT FROM AUTHOR]

Objective  The balance between oxidant and antioxidant defense mechanisms is crucial. In this article, we aimed to evaluate the role of this balance in community-acquired pneumonia (CAP) in children. Methods  We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic data of children with CAP and compared them with healthy controls. Serum total antioxidant status (TAS) and total oxidant status (TOS) were evaluated and compared between the groups, along with levels of ischemia-modified albumin (IMA), antioxidant enzymes, nonenzymatic antioxidant factors, and plasma thiol. Results  Of 160 children evaluated, 106 had CAP (54 outpatients and 52 inpatients), and the other 54 were healthy (control group). Total thiol and native thiol levels were significantly lower in the inpatient group compared with the outpatient group (p  = 0.004 and p  = 0.005, respectively). Serum IMA differed significantly among the groups (p  = 0.001), with inpatients showing the highest level. A positive correlation was found between serum IMA and C-reactive protein levels in patients with pneumonia (r  = 0.351; p  = 0.001). Conclusion  Parameters that provide information about antioxidant capacity may be useful in the diagnosis and prognosis of pneumonia. Our results suggest that plasma thiol levels and IMA may be good candidate biomarkers to predict hospitalization for CAP in children. [ABSTRACT FROM AUTHOR]

It is still not fully understood how to predict the future prognosis of patients at the diagnosis coronavirus disease 2019 (COVID‐19) due to the wide clinical range of the disease. We aimed to evaluate whether severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) viral load could predict the clinical course of pediatric patients. This study was conducted retrospectively with medical records of pediatric patients who were tested for SARS‐CoV2 between April 12 and October 25, 2020 in the University of Health Sciences, Ankara Educating and Training Hospital and Hacettepe University Faculty of Medicine. We evaluated 518 pediatric patients diagnosed with COVID‐19 and classified according to severity as asymptomatic (16.2%), mild (59.6%), moderate (20.2%), and critical/severe (3.9%) cases. We analyzed patients in four groups in terms of ages: <4, 5‐9, 10–14, and 15–17 years. There was no statistically significant difference in terms of ∆Ct value among age groups, different gender and the existence of underlying diseases in each disease course. The ∆Ct values were relatively lower in the first 2 days of symptoms than after days in all groups. Our study has indicated that children with COVID‐19 have similar amount of viral load in all disease courses irrespective of the age and underlying disease. It should be taken into account that, regardless of the severity of the disease, pediatric patients may have a role in the transmission chain. Research Highlights: Children with COVID‐19 can carry similar amount of viral load in all disease courses irrespective of the age and underlying disease.The viral load has no prediction utility in terms of the clinical course of children with COVID‐19.Regardless of the severity of the disease, pediatric patients may have a role in the transmission chain. [ABSTRACT FROM AUTHOR]

Introduction: Limited data are available for pediatric patients with coronavirus disease 2019 (COVID-19), especially with regard to disease management strategies. Objective: To assess the children with COVID-19. Method: We conducted a retrospective review of the medical records of pediatric patients on March 11 and May 23, 2020. Results: We evaluated 77 COVID-19 pediatric patients, of whom 45.5% were male, with a median age of 8 years (interquartile range [IQR] = 2-13), and 6.4% had underlying diseases. Patients were classified according to severity, with the percentages of asymptomatic, mild, moderate, and critical/severe cases determined to be 24.7%, 41.6%, 29.9%, and 3.9%, respectively. Extracorporeal membrane oxygenation and mechanic ventilation were only required for 1 patient. Targeted therapies were used in 3 patients. Conclusion: The disease course of COVID-19 appears to be milder in children than in adults, and the treatment course primarily consists of supportive care. [ABSTRACT FROM AUTHOR]

Background Myocarditis is an inflammatory condition located mainly in the myocardium. It is caused by a variety of bacterial and viral infections. Influenza is one of the most common relevant viruses that cause myocarditis. Objectives We attempted to share our experiences about clinical and laboratory findings, cardiac evaluation, and treatment of children with influenza myocarditis. Methods This retrospective study was performed by the Department of Pediatric Infectious Diseases at the Faculty of Medicine, Hacettepe University in Turkey. The medical records of patients diagnosed with myocarditis associated with an influenza infection between January 2014 and January 2017 were systematically reviewed. Results Vaccination seems likely to be an important protection strategy for both influenza infections and complications. [ABSTRACT FROM AUTHOR]

Background: Rapid development and global spread of multidrug resistant Klebsiella pneumonia (K. pneumoniae)as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes. Methods: A retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality. Results: Among 111 K. pneumoniae isolates 62% (n = 69) were ESBL -producing K. pneumoniae. The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively (p = 0.001). Previous aminoglycoside use was higher in cases with ESBL -producing isolates (p = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p =0.01). Conclusion: ESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI. [ABSTRACT FROM AUTHOR]

Carbapenems are often considered the last resort agents reserved for treatment of infections due to highly antimicrobial resistant organisms such as A. baumannii and P. aeruginosa. However, carbapenem-resistant Gram-negative (CRGN) pathogens have become much more prevalent in the last decade. The objective of this study was to determine risk factors for and outcome of bacteremia caused by Gram-negative microorganisms in a pediatric tertiary-care hospital. Among 97 patients with hospital-acquired Gram-negative bacteremia, 66 patients with carbapenem-susceptible Gram-negative pathogens (CSGN) were compared with the remaining 31 with CRGN isolates. The overall clinical response and microbiological response rates were 83.3% and 43.9% in CSGN group, and 54.8% and 32.3% in CRGN group, respectively ( P = 0.002 and P = 0.004, respectively). The treatment failure and relapse rates were 18.2% and 6.1% in CSGN group, and 38.7% and 6.5% in CRGN group, respectively ( P = 0.03 in each). The infection-related mortality rates were 10.8% in the CSGN group and 32.3% in the CRGN group ( P = 0.01). The total length of stay in hospital before infection was longer in patients with CRGN bacteremia than that of the CSGN bacteremia ( P = 0.002). The extended spectrum antibiotic usage prior to infection was significantly different between the groups ( P = 0.008). Infections due to CRGN are generally associated with poorer patient outcomes. Longer hospital stay and extended spectrum antibiotic usage prior to infection are the most important risk factors for CRGN bacteremia in our cohort. [ABSTRACT FROM AUTHOR]