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2. Guideline adherence in febrile children below 3 months visiting European Emergency Departments

Author

Tan, C.D., Walle, E.E.P.L. van der, Vermont, C.L., Both, U. von, Carrol, E.D., Eleftheriou, I., Emonts, M., Flier, M. van der, Groot, R. de, Herberg, J., Kohlmaier, B., Levin, M., Lim, E., Maconochie, I.K., Martinon-Torres, F., Nijman, R.G., Pokorn, M., Rivero-Calle, I., Tsolia, M., Yeung, S., Zenz, W., Zavadska, D., Neeleman, C., Gool, A.J. van, Gloerich, J., Huijnen, M.A., Moll, H.A., Pediatrics, Internal Medicine, Radiation Oncology, AII - Infectious diseases, Amsterdam Reproduction & Development (AR&D), European Commission, National Institute of Health and Medical Research, Adult Psychiatry, APH - Mental Health, ANS - Complex Trait Genetics, ANS - Mood, Anxiety, Psychosis, Stress & Sleep, Landsteiner Laboratory, Paediatric Infectious Diseases / Rheumatology / Immunology, ARD - Amsterdam Reproduction and Development, AII - Inflammatory diseases, Paediatrics, Graduate School, University of Zurich, and Union), PERFORM consortium (Personalised Risk assessment in febrile children to optimize Real-life Management across the European

Subjects
Fever, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], INFANTS, 610 Medicine & health, Guideline, Pediatrics, 1117 Public Health and Health Services, Humans, Child, Children, Science & Technology, PERFORM consortium (Personalised Risk assessment in febrile children to optimize Real-life Management across the European Union), Infant, Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6], SERIOUS BACTERIAL-INFECTIONS, Bacterial Infections, 10027 Clinic for Neonatology, Anti-Bacterial Agents, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Pediatrics, Perinatology and Child Health, 1114 Paediatrics and Reproductive Medicine, Emergency care, Guideline Adherence, Emergency Service, Hospital, Life Sciences & Biomedicine, Biomarkers
Abstract

Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0–18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0–2.3). Management per ED varied as follows: use of diagnostic tests 14–83%, antibiotic treatment 23–54%, admission 34–86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0–38%), partial adherence occurred in 56% (484/868, range 35–77%).Conclusion: There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children. What is Known:• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment.• There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence. What is New:• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe.• Guideline revision including new biomarkers is needed to improve management in young febrile children.

Published
2022
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3. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study

Author

Noguera-Julian A., Calzada-Hernandez J., Brinkmann F., Roy R. B., Bilogortseva O., Buettcher M., Carvalho I., Chechenyeva V., Falcon L., Goetzinger F., Guerrero-Laleona C., Hoffmann P., Jelusic M., Niehues T., Ozere I., Shackley F., Suciliene E., Welch S. B., Scholvinck E. H., Ritz N., Tebruegge M., Curtis N., Villanueva P., Marais B., Britton P., Clark J., Pichler J., Zschocke A., Bogyi M., Dreesman A., Mouchet F., Velizarova S., Pavic I., Nygaard U., Pulsen A., Kontturi A., Salo E., Chadelat K., Kruger R., Tee S., Ahrens F., Barker M., Zimmermann T., Schulze-Sturm U., Kaiser-Labusch P., Tsolia M., Ghanaie O. M., Buonsenso D., Lo Vecchio A., Ivaskeviciene I., Vilc V., Smyrnaios A., Arbore A. S., Starshinova A., Solovic I., Krivec U., Aldeco M., Espiau M., Soriano-Arandes A., Neth O., Santiago B., Gomez-Pastrana D., Blazquez D., Bustillo M., Perez-Porcuna T. M., Cilleruelo M. J., Kotz K., Bennet R., Relly C., Niederer-Loher A., Rochat I., Pavskyi S., Riordan A., Doherty C., Bamford A., Shingadia D., Emonts M., Ferreras-Antolin L., McMaster P., Moriarty P., Noguera-Julian, A., Calzada-Hernandez, J., Brinkmann, F., Roy, R. B., Bilogortseva, O., Buettcher, M., Carvalho, I., Chechenyeva, V., Falcon, L., Goetzinger, F., Guerrero-Laleona, C., Hoffmann, P., Jelusic, M., Niehues, T., Ozere, I., Shackley, F., Suciliene, E., Welch, S. B., Scholvinck, E. H., Ritz, N., Tebruegge, M., Curtis, N., Villanueva, P., Marais, B., Britton, P., Clark, J., Pichler, J., Zschocke, A., Bogyi, M., Dreesman, A., Mouchet, F., Velizarova, S., Pavic, I., Nygaard, U., Pulsen, A., Kontturi, A., Salo, E., Chadelat, K., Kruger, R., Tee, S., Ahrens, F., Barker, M., Zimmermann, T., Schulze-Sturm, U., Kaiser-Labusch, P., Tsolia, M., Ghanaie, O. M., Buonsenso, D., Lo Vecchio, A., Ivaskeviciene, I., Vilc, V., Smyrnaios, A., Arbore, A. S., Starshinova, A., Solovic, I., Krivec, U., Aldeco, M., Espiau, M., Soriano-Arandes, A., Neth, O., Santiago, B., Gomez-Pastrana, D., Blazquez, D., Bustillo, M., Perez-Porcuna, T. M., Cilleruelo, M. J., Kotz, K., Bennet, R., Relly, C., Niederer-Loher, A., Rochat, I., Pavskyi, S., Riordan, A., Doherty, C., Bamford, A., Shingadia, D., Emonts, M., Ferreras-Antolin, L., Mcmaster, P., and Moriarty, P.

Subjects
reactivation, Disease, anti-TNF-alpha, 0302 clinical medicine, Medicine, children, 030212 general & internal medicine, JUVENILE IDIOPATHIC ARTHRITIS, Child, Anti–TNF-alpha, RISK, Latent tuberculosis, GAMMA RELEASE ASSAYS, Miliary tuberculosi, SERIOUS INFECTION, Infectious Diseases, tuberculosis, anti–TNF-alpha, medicine.drug, miliary tuberculosis, Microbiology (medical), Adult, medicine.medical_specialty, Miliary tuberculosis, Tuberculosis, Adolescent, CORTICOSTEROIDS, Tuberculin, DIAGNOSIS, CLASSIFICATION, 03 medical and health sciences, Necrosis, Latent Tuberculosis, Internal medicine, SURVEILLANCE, INFLIXIMAB, Humans, Retrospective Studies, 030203 arthritis & rheumatology, business.industry, Tuberculin Test, Tumor Necrosis Factor-alpha, Retrospective cohort study, medicine.disease, FACTOR INHIBITORS, Infliximab, Clinical research, business, Interferon-gamma Release Tests
Abstract

Background In adults, anti–tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. Methods Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients Results Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn’s disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti–TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti–TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1–20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46–66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. Conclusions LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti–TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.

Published
2019

4. Community-associated Staphylococcus aureus pneumonia among Greek children: epidemiology, molecular characteristics, treatment, and outcome.

Author

Doudoulakakis, A., Bouras, D., Drougka, E., Kazantzi, M., Michos, A., Charisiadou, A., Spiliopoulou, I., Lebessi, E., and Tsolia, M.

Subjects
STAPHYLOCOCCUS aureus infections, PNEUMONIA in children, CHILDREN'S health, CHILDREN, MOLECULAR microbiology, THERAPEUTICS
Abstract

Staphylococcus aureus is an infrequent cause of community-associated (CA-SA) pneumonia in children. The aim of this study was to evaluate the clinical, epidemiological, microbiological, and molecular characteristics of CA-SA pneumonia among children hospitalized in two large tertiary care referral centers during an 8-year period. Cases of CA-SA pneumonia admitted between 2007 and 2014 were retrospectively examined through medical record review. Molecular investigation was performed for available strains; mecA, Panton-Valentine leukocidin (PVL) ( lukS-lukF-PV), and fibronectin binding protein A ( fnbA) genes were detected by polymerase chain reaction (PCR). Clones were assigned by agr groups, pulsed-field gel electrophoresis (PFGE), SCC mec, and multilocus sequencing typing (MLST). In total, 41 cases were recorded (boys, 61 %), with a median age of 4.3 months (range, 1-175). Methicillin-resistant S. aureus (MRSA) accounted for 31 cases (75.6 %). Complications included empyema (25/41, 61 %), pneumatoceles (7/41, 17 %), and lung abscess (1/41, 2.5 %). Intensive care unit (ICU) admission was required in 58.5 %. Two deaths occurred (4.9 %). Definitive therapy was based on vancomycin with or without other antibiotics (55.9 %), followed by clindamycin and linezolid (26.5 % each). All isolates were susceptible to vancomycin (MIC 2 mg/L, range 1-2), teicoplanin, and linezolid, whereas 26.8 % were resistant to clindamycin. Among the 25 studied strains, 20 were mecA-positive (MRSA), carrying also the fnbA gene. Of these, 90 % belonged to the ST80-IV/ agr3/PVL-positive clone. Methicillin-susceptible S. aureus (MSSA) strains showed polyclonality, 3/5 were PVL-positive, and 3/5 were fnbA-positive. MRSA and particularly the ST80-IV clone predominated among staphylococcal pneumonia cases in children. Treatment provided was effective in all but two patients, despite the relatively high minimum inhibitory concentration (MIC) of vancomycin and a high resistance to clindamycin. [ABSTRACT FROM AUTHOR]

Published
2016
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5. Variation in paediatric hospital antibiotic guidelines in Europe.

Author

Spyridis, N., Syridou, G., Goossens, H., Versporten, A., Kopsidas, J., Kourlaba, G., Bielicki, J., Drapier, N., Zaoutis, T., Tsolia, M., Sharland, M., and ARPEC Project Group Members

Subjects
ANTIBIOTICS, PEDIATRIC therapy, GUIDELINES, URINARY tract infections in children, RESPIRATORY infections in children, AMOXICILLIN, CHILDREN, THERAPEUTICS, BACTERIAL diseases, CHILDREN'S hospitals, COMPARATIVE studies, DRUG administration, RESEARCH methodology, MEDICAL cooperation, MEDICAL protocols, MEDICAL prescriptions, RESEARCH, RESPIRATORY infections, SEPSIS, URINARY tract infections, EVALUATION research, CROSS-sectional method, STANDARDS
Abstract

Objective: To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.Design: Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.Results: 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.Conclusions: Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates. [ABSTRACT FROM AUTHOR]

Published
2016
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6. Pandemic influenza A vs seasonal influenza A in hospitalized children in Athens.

Author

Stripeli, F., Logotheti, I., Vraila, V. M., Balta, C., Patsioura, A., Papaevangelou, V., Papadatos, I., Baka, A., Tsiodras, S., and Tsolia, M. N.

Subjects
H1N1 influenza, INFLUENZA A virus, SEASONAL influenza, EPIDEMIOLOGICAL research, OTITIS media, AGE distribution
Abstract

Background: Data on pandemic H1N1 influenza (pH1N1) virus infection in hospitalised children are limited. Aims and Objectives: To examine the epidemiological and clinical characteristics of children hospitalised with pH1N1 at a large tertiary-care centre in Athens and compare them with those of children hospitalised with seasonal influenza A in previous years. Methods: All children (n = 146) admitted with confirmed pH1N1 between October 2009 to February 2010 and January 2011 to May 2011 were included. Data on children ≧6 months of age (n = 109) were compared with those of 138 children admitted with seasonal influenza A who were examined during two previous influenza seasons (2002–2003 and 2004–2005). Results: The age distribution was similar between seasonal and pandemic H1N1. Bronchial asthma was significantly more common in the seasonal influenza group but the clinical presentation was similar in the two groups, except that fever was more common in patients with pH1N1. Children admitted with seasonal influenza were more likely to develop acute otitis media. There were no significant differences between the two groups for severe outcomes (admission to the ICU, mechanical ventilation or death). Only one child with seasonal influenza (0·6%) and three with pH1N1 influenza (2%) required admission to the ICU. Mean length of hospitalisation was longer in the seasonal influenza group. Conclusion: Clinical manifestations were similar between pH1N1 and seasonal influenza, and the pandemic virus did not appear to cause more severe disease in hospitalised children. [ABSTRACT FROM AUTHOR]

Published
2015
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7. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Author

Benoît Bernar, Astrid Rojahn, Laura Jones, Elisabeth Schölvinck, Robin Kobbe, Laura Lancella, Delane Shingadia, Fiona Shackley, Lynne McFetridge, Conor Doherty, Cornelius Rau, Nicolaus Schwerk, Oksana Kozdoba, Koen Vanden Driessche, Arnaud G L'Huillier, Jasmin Pfefferle, Srini Bandi, R Song, Andreia Ribeiro, Ivan Solovic, Jonathan P. Glenthoej, Ulrich Heininger, Susana Melendo, Tine Boiy, Uros Krivec, An Bael, Luca Pierantoni, Edda Haberlandt, Miguel Lanaspa, Noémie Wagner, Andrea Lo Vecchio, Francesc Ripoll, Lise Heilmann Jensen, Piero Valentini, Anita Niederer, Roland Berger, Nicole Ritz, Aida M. Gutiérrez-Sánchez, Christelle Christiaens, Franziska Zucol, Katy Fidler, Jolanta Bernatoniene, Anna Starshinova, Volker Strenger, Claus Klingenberg, Ilona Lind, Clare S. Murray, Angela Zacharasiewicz, Ivan Pavic, Amanda Williams, Christina Thir, Vera Chechenyeva, Karsten Kötz, Stephanie Thee, Laura Buchtala, Danilo Buonsenso, Patrick Gavin, Rimvydas Ivaškevicius, Sara Debulpaep, Francesca Ippolita Calò Carducci, Marine Creuven, Beatriz Soto, Srđan Roglić, Lola Falcón, Yvonne Beuvink, Petra Zimmermann, Petra Schelstraete, Lynne Speirs, Daniela S. Kohlfürst, Antoni Noguera-Julian, Mihhail Tistsenko, Steven B. Welch, Hanna Schmid, Anastasios Smyrnaios, Laura Minguell, Andrew Riordan, Michael Buettcher, Angelika Berger, Isabel Carvalho, Daan Van Brusselen, Inga Ivaškeviciene, Matilde Bustillo, Valentina Vilc, Folke Brinkmann, Nina Krajcar, Olaf Neth, Alicia Demirjian, Matthias Bogyi, Ulle Uustalu, Maria Tsolia, Borja Ibanez, Elisabeth Whittaker, Ariane Biebl, Irini Eleftheriou, Burkhard Simma, Petra Prunk, Borbàla Zsigmond, Veronika Osterman, Zoe Oliver, Antoni Soriano-Arandes, Ulrikka Nygaard, Marcello Lanari, Marc Tebruegge, Olga Bilogortseva, Michael Barker, Svetlana Velizarova, Florian Götzinger, Natalia Gabrovska, Begoña Santiago-García, Benhur Şirvan Çetin, Paddy McMaster, Anna Zschocke, Frances Child, Nick Makwana, Mar Santos, Group, ptbnet COVID-19 Study, Gotzinger F., Santiago-Garcia B., Noguera-Julian A., Lanaspa M., Lancella L., Calo Carducci F.I., Gabrovska N., Velizarova S., Prunk P., Osterman V., Krivec U., Lo Vecchio A., Shingadia D., Soriano-Arandes A., Melendo S., Lanari M., Pierantoni L., Wagner N., L'Huillier A.G., Heininger U., Ritz N., Bandi S., Krajcar N., Roglic S., Santos M., Christiaens C., Creuven M., Buonsenso D., Welch S.B., Bogyi M., Brinkmann F., Tebruegge M., Pfefferle J., Zacharasiewicz A., Berger A., Berger R., Strenger V., Kohlfurst D.S., Zschocke A., Bernar B., Simma B., Haberlandt E., Thir C., Biebl A., Vanden Driessche K., Boiy T., Van Brusselen D., Bael A., Debulpaep S., Schelstraete P., Pavic I., Nygaard U., Glenthoej J.P., Heilmann Jensen L., Lind I., Tistsenko M., Uustalu U., Buchtala L., Thee S., Kobbe R., Rau C., Schwerk N., Barker M., Tsolia M., Eleftheriou I., Gavin P., Kozdoba O., Zsigmond B., Valentini P., Ivaskeviciene I., Ivaskevicius R., Vilc V., Scholvinck E., Rojahn A., Smyrnaios A., Klingenberg C., Carvalho I., Ribeiro A., Starshinova A., Solovic I., Falcon L., Neth O., Minguell L., Bustillo M., Gutierrez-Sanchez A.M., Guarch Ibanez B., Ripoll F., Soto B., Kotz K., Zimmermann P., Schmid H., Zucol F., Niederer A., Buettcher M., Cetin B.S., Bilogortseva O., Chechenyeva V., Demirjian A., Shackley F., McFetridge L., Speirs L., Doherty C., Jones L., McMaster P., Murray C., Child F., Beuvink Y., Makwana N., Whittaker E., Williams A., Fidler K., Bernatoniene J., Song R., Oliver Z., Riordan A., Gotzinger, F., Santiago-Garcia, B., Noguera-Julian, A., Lanaspa, M., Lancella, L., Calo Carducci, F. I., Gabrovska, N., Velizarova, S., Prunk, P., Osterman, V., Krivec, U., Lo Vecchio, A., Shingadia, D., Soriano-Arandes, A., Melendo, S., Lanari, M., Pierantoni, L., Wagner, N., L'Huillier, A. G., Heininger, U., Ritz, N., Bandi, S., Krajcar, N., Roglic, S., Santos, M., Christiaens, C., Creuven, M., Buonsenso, D., Welch, S. B., Bogyi, M., Brinkmann, F., Tebruegge, M., Pfefferle, J., Zacharasiewicz, A., Berger, A., Berger, R., Strenger, V., Kohlfurst, D. S., Zschocke, A., Bernar, B., Simma, B., Haberlandt, E., Thir, C., Biebl, A., Vanden Driessche, K., Boiy, T., Van Brusselen, D., Bael, A., Debulpaep, S., Schelstraete, P., Pavic, I., Nygaard, U., Glenthoej, J. P., Heilmann Jensen, L., Lind, I., Tistsenko, M., Uustalu, U., Buchtala, L., Thee, S., Kobbe, R., Rau, C., Schwerk, N., Barker, M., Tsolia, M., Eleftheriou, I., Gavin, P., Kozdoba, O., Zsigmond, B., Valentini, P., Ivaskeviciene, I., Ivaskevicius, R., Vilc, V., Scholvinck, E., Rojahn, A., Smyrnaios, A., Klingenberg, C., Carvalho, I., Ribeiro, A., Starshinova, A., Solovic, I., Falcon, L., Neth, O., Minguell, L., Bustillo, M., Gutierrez-Sanchez, A. M., Guarch Ibanez, B., Ripoll, F., Soto, B., Kotz, K., Zimmermann, P., Schmid, H., Zucol, F., Niederer, A., Buettcher, M., Cetin, B. S., Bilogortseva, O., Chechenyeva, V., Demirjian, A., Shackley, F., Mcfetridge, L., Speirs, L., Doherty, C., Jones, L., Mcmaster, P., Murray, C., Child, F., Beuvink, Y., Makwana, N., Whittaker, E., Williams, A., Fidler, K., Bernatoniene, J., Song, R., Oliver, Z., and Riordan, A.

Subjects
Male, Delivery of Health Care / organization & administration, medicine.medical_treatment, Coronavirus Infections / therapy, Coronavirus Infections / epidemiology, law.invention, Patient Admission, 0302 clinical medicine, law, Risk Factors, COVID-19, children, Europe, Developmental and Educational Psychology, 030212 general & internal medicine, Child, ddc:618, Intensive care unit, Coronavirus, SARS-CoV-2, child, treatment, intensive care, Intensive Care Units, N/A, Child, Preschool, Female, Europe / epidemiology, Coronavirus Infections, Human, Cohort study, medicine.medical_specialty, Pneumonia, Viral / epidemiology, Intensive Care Unit, Pneumonia, Viral, Patient Admission / trends, Intensive Care Units / organization & administration, Article, Follow-Up Studie, 03 medical and health sciences, Betacoronavirus, 030225 pediatrics, Internal medicine, Lower respiratory tract infection, medicine, Extracorporeal membrane oxygenation, Humans, Pediatrics, Perinatology, and Child Health, Pandemics, Pneumonia, Viral / therapy, Mechanical ventilation, Betacoronaviru, Coronavirus Infection, business.industry, Risk Factor, Infant, Newborn, Infant, Odds ratio, medicine.disease, ptbnet COVID-19 Study Group, Clinical research, El Niño, Pediatrics, Perinatology and Child Health, business, Delivery of Health Care, Follow-Up Studies
Abstract

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one ( Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.

Published
2020

8. Impact of influenza infection on children's hospital admissions during two seasons in Athens, Greece

Author

Sakkou, Z., Stripeli, F., Papadopoulos, N.G., Critselis, E., Georgiou, V., Mavrikou, M., Drossatou, P., Constantopoulos, A., Kafetzis, D., and Tsolia, M.

Subjects
*INFLUENZA, *DISEASE incidence, *JUVENILE diseases, *IMMUNIZATION, *HOSPITAL care, *EPIDEMIOLOGY, *NASOPHARYNX diseases, *POLYMERASE chain reaction, *FEBRILE seizures, *ACUTE otitis media
Abstract

Abstract: A prospective epidemiologic surveillance of hospitalizations associated with influenza was conducted in order to calculate population-based hospitalization rates. Eligible children were 6 months to 13 years of age and were admitted to one of the two large children''s hospitals in the Athens area during two influenza seasons. Nasopharyngeal aspirates were tested for influenza by a polymerase reaction assay. Influenza accounted for 9.9–11.8% of all admissions during the influenza season and the overall annual rate of hospitalizations was 13.6–16.8 cases per 10,000 children being highest for children under 5 years of age (26–31.2/10,000 children). Febrile seizures and acute otitis media were the two most common complications associated with influenza and antibiotics were administered to 61% of flu positive patients. Influenza is associated with high hospitalization rates among young children and these may be substantially reduced with the introduction of routine immunization. [Copyright &y& Elsevier]

Published
2011
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