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The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities. [ABSTRACT FROM AUTHOR]

Transposition of the aorta to redirect right ventricular flow to the systemic circulation (the Norwood procedure) can improve the survival chances of children with hypoplastic left heart syndrome (HLHS), but may cause intellectual impairment. The procedure improves cardiac output in children with inadequate left ventricles, and redirects right ventricular flow to the aorta to supply the body with oxygenated blood. Researchers believe that stopping the heart during the surgery causes neurodevelopmental delays and impaired intellectual performance in the surviving children., Objective. To assess intellect and adaptive behavior in children with hypoplastic left heart syndrome (HLHS) who had undergone at least two surgical stages of the Norwood procedure. Methods. Fourteen children with HLHS [is greater than] 3 years of age participated in the study. The patients underwent intelligence quotient (IQ) testing, and their parents were interviewed regarding their children's adaptive behavior. Results were compared with those of 10 family controls. Outcomes were studied for possible correlation with perioperative variables. Results. Among the HLHS patients, the median scores for full scale IQ and adaptive behavior were 88 and 91, respectively (normal = 100 [+ or -] 15). One child met criteria for mental retardation. Family controls scored generally higher than did HLHS patients, but only differences in adaptive behavior were statistically significant. A negative correlation was found between stage I circulatory arrest time and full scale IQ. Conclusions. Children with HLHS most often function in the low-normal range of intelligence and adaptive behavior. A prolonged circulatory arrest time may result in decreased intellectual function. congenital heart disease, cardiac surgery, neurodevelopment., ABBREVIATIONS. HLHS, hypoplastic left heart syndrome; WPPSI-R, Wechsler Preschool and Primary Scale of Intelligence-Revised; IQ, intelligence quotient; PPVT, Peabody Picture Vocabulary Test; VMI, Beery Visual Motor Integration Test; VABS, Vineland [...]

The only reliable indicator of coarctation of the aorta (COA) in children may be a blood pressure difference between arms and legs, and this indicator may be used to screen all children for COA. COA is a common heart defect. Early repair of COA may reduce the risk of cardiovascular disease in adult life. Researchers reviewed medical records of 50 children who underwent surgery to correct COA. The most reliable findings of COA were heart murmurs and a systolic blood pressure difference of more than 10 mm Hg between arms and legs., Because late repair of coarctation of the aorta (COA) is associated with premature cardiovascular disease in adult life, early detection and treatment is important. Objectives. To determine the timing of referral to see whether early detection of COA has improved in the past decade, to evaluate the pattern of and reasons for medical center referral, and to assess the clinical signs relating to the diagnosis of COA. Methods. The records of 50 consecutive patients older than 1 year who had surgical repair of COA from 1980 to 1990 were reviewed. The age of referral, pattern of referral, and presence of standard clinical signs of COA were analyzed, and data were compared with those from the previous decade. Results. The mean and median ages at referral were 8.4 and 5.8 years, respectively. Pediatricians accounted for 64% of the referrals. A specific diagnosis of COA was made in 2 (4%) of 50 patients before referral to a pediatric cardiologist. The most consistent clinical findings were a cardiac murmur and a systolic blood pressure gradient between the arms and legs of greater than 10 mm Hg, which were both present in all patients. Lower-extremity pulses were decreased in 37 (74%) and absent in 9 (18%). Forty-seven children (94%) had upper-extremity hypertension (>95th percentile for age); 25 (50%) had systolic blood pressure higher than 140 mm Hg. COA would have been missed in 82% of children if absent lower-extremity pulses were required as a diagnostic feature. These findings were similar to those reported by our institution in the previous decade, suggesting that early detection has not improved. Conclusions. The timing of, reasons for, and sources of referral for COA in this study, compared with data from the previous decade, indicate no improvement in early detection of COA by pediatricians. Screening all children for COA by routinely measuring upper- and lower-extremity blood pressures during at least one physical examination after the newborn period is mandatory. Pediatrics 1996;98:378-382; coarctation of the aorta, repair, diagnosis., ABBREVIATION. COA, coarctation of the aorta. Coarctation of the aorta (COA)is a common cardiovascular malformation accounting for 5% to 8% of patients with congenital heart disease.[1] The classic clinical signs [...]

Kawasaki disease (mucocutaneous lymph node syndrome) usually affects young children, causing fever, inflammation of the mucous membranes of the mouth, 'strawberry tongue,' rash, and other symptoms. It may involve the heart, causing narrowing of the coronary arteries and myocardial infarction (heart attack) occurring months or years after the initial illness. A genetic predisposition may be involved. Kawasaki disease is more common among Asians, and peaks in incidence between December and May. Mortality is highest among children under two years of age. The symptoms, including cardiovascular features, are described. Half of the patients with coronary aneurysms (dilations of the walls of the coronary arteries, which bring blood to the heart) have no complications, but large aneurysms (affecting about 5 percent of patients) frequently lead to blockage of the coronary arteries and heart attacks, and in extreme cases, death. In one survey of patients who had died of Kawasaki disease, half died within two months of the acute illness, but 20 percent died more than a year later. Treatment of the disease includes aspirin therapy, which relieves symptoms but may not be effective against coronary aneurysm. Gamma globulin therapy may be effective in preventing coronary aneurysms, and has been found to cause no serious complications. In cases of severe coronary artery involvement, coronary artery bypass grafts may be required. Balloon angioplasty and clot-dissolving therapy have had limited success. Long-term treatment for patients with varying degrees of complications is discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

The best method of screening children for elevated cholesterol has not been established. Current recommendations are to screen children who have a family history of either elevated blood lipid (fat) levels or early onset of coronary heart disease. It has been suggested that this method of screening may miss many children with hypercholesterolemia (elevated cholesterol levels in the blood). A study was undertaken to determine if detailed family histories would have identified children later known to have moderate or severe hypercholesterolemia. A group of 114 children was studied. The age range of the children was 2 to 18 (average age 8.2 years) and 73 percent of the children were white. Most children came from upper-middle-class families. The guidelines of the American Academy of Pediatrics were used to define a positive family history. It was found that of children having total cholesterol levels greater than the 75th percentile, 22 percent did not have family histories for either hypercholesterolemia or premature coronary heart disease. Of children whose levels were greater than 95th percentile, 18.3 percent had negative histories. Seventy-eight children had both hypercholesterolemia and positive family history; 72 families reported hyperlipidemia and 27 premature coronary heart disease. These results suggest that a detailed family history fails to identify many children with hypercholesterolemia, as well as a high proportion of children with elevated cholesterol. Children who have hypercholesterolemia more often have family histories of hyperlipidemia rather than of early coronary heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)