Impact of Long COVID on Lung Function in Children.

Objective: While the coronavirus disease-2019 (COVID-19) pandemic has generally resulted in milder illness among children than adults, persistent respiratory symptoms have been increasingly reported in this population. Methods: We conducted a prospective, single-center cohort study focusing on children experiencing prolonged respiratory symptoms after contracting COVID-19. Spirometry, 6- minute walk tests (6MWTs), and tests of lung volume, the diffusing capacity of the lungs for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO) were performed on COVID-19 survivors at least 4 weeks after infection and a group of healthy control subjects. Results: Fifty-five children with long-term COVID and 55 healthy control subjects were recruited. The weight, height, and body mass index Z-scores were similar in the groups. Within a median duration of 85 days (minimummaximum: 35-194) following COVID-19 infection, a restrictive pattern was observed to be more common in the study group (p=0.021). In children with long COVID, 6MWT distances, DLCO Z-scores, and the predicted values of spirometry and lung volume tests were found to be significantly lower but in the normal range. The average predicted values for DLCO, FeNO, and 6MWT were similar in the two groups. Conclusions: Prolonged respiratory symptoms often persist long after COVID-19 infection, necessitating comprehensive evaluation of affected children. Close monitoring, including spirometry and lung volume assessments, is crucial for children with abnormalities in lung imaging. However, FeNO measurements were found to be ineffective in monitoring long COVID.

Long-term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy (ISPAT) project.

BACKGROUND AND OBJECTIVES: Children with tracheostomies are at increased risk of tracheostomy-related complications and require extra care. Standardized training programs for caregivers can improve tracheostomy care and reduce complications. In this study, we compared caregiver knowledge and skill scores after a standardized theoretical and practical training program on tracheostomy care (IStanbul PAediatric Tracheostomy (ISPAT) project) immediately and 1 year post-training and evaluated how this training affected the children's clinical outcomes. MATERIALS AND METHODS: We included 32 caregivers (31 children) who had received standardized training a year ago and administered the same theoretical and practical tests 1 year after training completion. We recorded tracheostomy-related complications and the number and reasons for admission to the healthcare centers. All data just before the training and 1 year after training completion were compared. RESULTS: After 1 year of training completion, the median number of correct answers on the theoretical test increased to 16.5 from 12 at pretest (p < 0.001). Compared with pretest, at 1-year post-training practical skills assessment scores, including cannula exchange and aspiration, were significantly higher (both p < 0.001) and mucus plug, bleeding, and stoma infection reduced significantly (p = 0.002, 0.022, and 0.004, respectively). Hands-on-training scores were better than pretest but declined slightly at 1 year compared to testing immediately after training. Emergency admission decreased from 64.5% to 32.3% (p = 0.013). Hospitalization decreased from 61.3% to 35.5% (p = 0.039). CONCLUSION: Our findings indicate that caregiver training can lead to a persistent increase in knowledge and skill for as long as 1 year, as well as improvements in several measurable outcomes, although a slight decrease in scores warrants annual repetitions of the training program.

The First Definition of Pulmonary Component of Hypereosinophilic Syndrome: Bronchial Casts.

Hypereosinophilic syndrome is a heterogeneous disease characterized by eosinophilic tissue inflammation and eosinophilia. Pulmonary involvement could be seen in up to 55% among children with hypereosinophilic syndrome. A 3-year-old boy with chronic hypereosinophilia and respiratory complaints was diagnosed with idiopathic hypereosinophilic syndrome. Atelectasis was detected in the radiological evaluation, and bronchial casts with eosinophilic structures were removed by bronchoscopy. Steroid, inhaled hypertonic saline, inhaled bronchodilator, inhaled corticosteroid, and leukotriene receptor antagonist were used for 1 year in the management of hypereosinophilic syndrome, and related eosinophilic casts and repetitive bronchoscopies were administered for removal of the casts. The patient was successfully managed with an inhaled N-acetyl cysteine treatment. In children, the long-term prognosis of hypereosinophilic syndrome is uncertain. Comprehensive diagnostic tests are required for the early diagnosis and management of pediatric hypereosinophilic syndrome. In the presented case, the rare occurrence of pulmonary involvement of hypereosinophilic syndrome in a 3 year-old-boy with recurrent hypereosinophilic casts and its management were discussed.

Did Hospital Admissions Caused by Respiratory Infections and Asthma Decrease During the COVID-19 Pandemic?

Objective: Despite maximum isolation measures taken during the coronavirus disease-2019 (COVID-19) pandemic, the workload of health institutions has increased. Consequently, changes in the number of admissions in clinics and emergency departments by disease groups have been observed. We aimed to quantitatively investigate the changes in the frequency of respiratory infections and asthma in the pediatric population during the COVID-19 pandemic. Methods: We analyzed electronic medical record data of patients who were admitted to the emergency department (ED), outpatient and inpatient clinics, and pediatric intensive care unit (PICU) because of influenza, upper and lower respiratory tract infections (URTI, LRTI), acute bronchiolitis, and asthma during the two-year period (one year pre-COVID period and first year of the pandemic). Results: There were 96,648 admissions in the pre-COVID period and 15,848 during the pandemic. We observed a decline in ED admissions (-73%), outpatient clinic visits (-70%), hospitalizations (-41.5%), and PICU admissions (-42%). While the admission rates of patients with influenza [from 4.26% to 0.37% (p=0.0001)] and URTI [from 81.54% to 75.62% (p=0.0001)] decreased, the ratio of the number of admissions to the total number of admissions due to LRTI [from 8.22% to 10.01% (p=0.0001)], acute bronchiolitis [from 2.76% to 3.07% (p=0.027)], and asthma [from 5.96% to 14% (p=0.0001)] increased. Conclusions: The decrease in viruses that cause acute bronchiolitis and asthma attacks lead to a reduction in admissions to ED of this patient group. The fact that parents preferred not to admit their child in ED during this period may have paved the way for the development of more severe LRTIs.

Effects of tracheostomy on mothers of children with cerebral palsy.

OBJECTIVE: We aimed to investigate psychosocial changes such as burnout, caregiver burden, depression, and coping in mothers of children with cerebral palsy (CP) after tracheostomy placement. DESIGN: A total of 48 children with CP and chronic respiratory insufficiency and their mothers participated in the study. The children with tracheostomy were classified as T (+) (n = 26) and those who did not have tracheostomy were classified as T (-) (n = 22). The patients with tracheostomy through invasive mechanical ventilation were classified as TIV (+). The data about the clinical conditions of the patients and the sociodemographic characteristics of the mothers were recorded. Zarit caregiver burden, Maslach burnout, Beck depression, and Coping Orientation to Problems Experienced (COPE) questionnaires were applied to all mothers. FINDINGS: Beck depression score was 14 ± 8.24 in T (+) group and 16.09 ± 9.65 in T (-) group (p = .576). There was no significant difference between the T (+) and T (-) groups in the Maslach burnout inventory, Zarit caregiver burden scale, and their subgroups. The first two methods from the COPE scales were identical. In the T (+) group, the third coping method was found as "planning" and in the T (-) group as "active coping". Maslach burnout inventory, Zarit 1, and Zarit 2 scores were higher in patients with only tracheostomy compared to those with TIV (p = .002, p = .018, p = .021). CONCLUSION: In the study presented, the placement of tracheostomy in children with CP does not increase mother's depression tendencies and mood changes.

Assessment of Nocturnal Hypoventilation by Different Methods and Definitions in Children with Neuromuscular Disease: Oxycapnography and Blood Gas Analysis.

OBJECTIVE: To investigate whether partial arterial carbon dioxide pressure (PaCO 2 ) level in arterial blood gas analysis that was used to predict nocturnal hypoventilation (NH) is concordant with nocturnal end-tidal CO 2 (PetCO 2 ) measurement obtained by a noninvasive method of oxycapnography in children with neuromuscular disease (NMD). METHODS: Twenty-one patients aged 6-18 years with a confirmed diagnosis of NMD were enrolled. Each patient underwent a nocturnal oxycapnography study using an orinasal probe and a pulse oximetry finger probe to record PetCO 2 , oxygen saturation (SpO 2 ), pulse rate, and respiratory rate. Arterial blood gas analysis was performed to record PaCO 2 levels on three occasions at night (23:00 pm, 03:00 am, 07:00 am). RESULTS: The mean overnight PaCO 2 level of the three blood gas analyses (mean PaCO 2 noct) was 41.78±4.69 mmHg. A significant change was observed between mean PaCO 2 23:00 and PaCO 2 07:00 levels (p=0.032). There was no significant difference between PaCO 2 , PetCO 2 , and SpO 2 levels in the NMD group. The interclass correlation coefficient between PaCO 2 07:00 and PetCO 2 levels was 0.791 (95% CI: 0.533-0.923); the interclass correlation coefficient between overnight mean PaCO 2 and PetCO 2 levels was 0.811 (95% CI:0.533-0.923). CONCLUSION: Our study indicates that nocturnal PetCO 2 and PaCO 2 levels were statistically comparable but the use of PaCO 2 alone is not adequate to make an early diagnosis of NH in NMD. There is a need for making more restrictive definitions for NH, and conducting studies with larger study populations to reach an agreement on the best definition of hypoventilation, and updating consensus guidelines.

Active Surveillance of Influenza A and Other Respiratory Viruses in Children with Influenza-like-illness in Two Seasons.

INTRODUCTION: The aim of this study was to asses the surveillance of influenza A/other respiratory viruses and risk factors in hospitalized children with the symptoms of influenza-like illness during two consecutive influenza seasons. METHODOLOGY: All children hospitalized with adiagnosis of influenza-like illness had been investigated for Influenza A and other respiratory antigens in pharengeal/nasopharyngeal secretions. RESULTS: A total of 132 hospitalized children between December 2013-May 2014 and December 2014-May 2015 were enrolled in this study. At least one respiratory virus was found to be positive by RT-PCR in 78 (59%) patients, influenza A (H3N2) was detected in only 8 (6%) patients. In 54 (41%) patients samples no respiratory viral pathogen was detected and in 70 (53%) patients, one non- influenza A virus was detected. The respiratory viral pathogens detected in decreasing rates were:RSV (n = 46, 35%), HCoV (n = 10, 7.5%), adenovirüs (n = 7, 5%), rhinovirüs (n = 6, 4.5%), HMPV (n = 5, 4%), Influenza B (n = 4, 3%) ve human Bocavirus (n = 2, 1.5%). In 10 patients, coinfection was detected, however none was with H3N2. In the H3N2 (+) group, the following risk factors were identified: age older than three years (p < 0.05), asthma history (p < 0.05) and chronic lung diseases (p < 0.05). CONCLUSION: Influenza A virus was detected in 6% of hospitalized patients with influenza-like illness. Viruses other then Influenza, especially RSV, can cause similar symptoms compatible with Influenza-like-illness.