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The aim of this study is to describe characteristics and hospital course of children admitted with COVID-19 to a tertiary care pediatric center in Southeastern United States, and to present the frequency of three classes of multisystem inflammatory syndrome in children (MIS-C) and develop pediatric COVID-19 associated hyperinflammation score (PcHIS). A retrospective cohort study of 68 children was performed. Critical illness was defined as any child requiring respiratory or cardiovascular support or renal replacement therapy. PcHIS was developed by using six variables: fever, hematological dysfunction, coagulopathy, hepatic injury, macrophage activation, and cytokinemia. Centers for Disease Control and Prevention criteria were used to identify MIS-C, and three classes of MIS-C were identified based on the findings of recently published latent class analysis (Class 1: MIS-C without Kawasaki like disease, Class 2: MIS-C with respiratory disease, and Class 3: MIS-C with Kawasaki like disease). The median age was 6.4 years. Fever, respiratory, and gastrointestinal were common presenting symptoms. MIS-C was present in 32 (47%), critical COVID-19 illness in 11 (16%), and 17 (25%) were admitted to the PICU. Children with critical illness were adolescents with elevated body mass index and premorbid conditions. PcHIS score of 3 had a sensitivity of 100% and a specificity of 77% for predicting critical COVID-19 illness. Among MIS-C patients, 15 (47%) were in Class 1, 8 (25%) were in Class 2, and 9 (28%) were in Class 3. We conclude that most children with COVID-19 have mild-to-moderate illness. Critical COVID-19 is mainly seen in obese adolescents with premorbid conditions. Three Classes of MIS-C are identifiable based on clinical features. Validation and clinical implication of inflammation score in pediatric COVID-19 need further investigation.

Urinary tract infections (UTIs) are among the most common causes of hospitalization in children, with a rising prevalence of extended-spectrum beta-lactamase-producing organisms (ESBL). The purpose of this study was to identify risk factors and treatment outcomes of children with ESBL-UTI. A retrospective case-control study of hospitalized children was performed from July 2014 till December 2017. Medical records from patients with a positive urine culture were reviewed and included in the study if they met criteria for UTI. Cases were defined as ESBL-UTI, while controls were defined as non-ESBL-UTI patients. This study confirmed that there are certain risk factors, such as previous UTI, recent antibiotic use, urinary tract abnormalities, recent hospital admission, and nonrenal comorbidities, that are associated with ESBL-UTI. Most of the patients with ESBL-UTI responded to discordant antibiotics. Other significant outcomes in patients with ESBL-UTI included a longer length of stay and longer intravenous antibiotic therapy.

INTRODUCTION/HYPOTHESIS: Vitamin-D (Vit-D) has an important immunomodulatory role and its deficiency has been linked to increased viral respiratory infections in the pediatric population Recent adult studies have shown an association between lower Vit-D levels and mortality in COVID-19 Low Vit-D levels are common in children with obesity and associated with enhanced systemic inflammation METHODS: This is an IRB approved, retrospective case series of children with COVID-19 admitted to a tertiary pediatric intensive care unit (PICU), describing the clinical features and 25-hydroxy-Vit-D levels Charts were reviewed and pertinent data collected Deidentified data were analyzed using SPSS v 26 Categorical data are presented as frequencies and percentages Continuous data presented as median with interquartile range (IQR) RESULTS: A total of 14 COVID-19 patients who had 25- OH Vit D levels measured were reviewed All patients had MIS-C (fever, inflammation, and 2 or more organ involvement) Demographic data included, females 50% (n=7), Hispanics 64 3% (n=9), whites 78 6% (n=11), and blacks, 21 4% (n=3) The median age was 15 (IQR 4 83) with 64% (n=9) teens Overweight or obese was present in 71 4% (n=10) Median BMI was 31 2 (IQR18 31) Vit-D deficiency (level