Early report from the Pediatric Heart Transplant Society on COVID-19 infections in pediatric heart transplant candidates and recipients.

BACKGROUND: Reports focused on adult heart transplant (HTx) recipients with COVID-19 suggest an increased risk of severe disease, however; it is unclear if this holds true for pediatric HTx patients, given the typically milder course of illness in children in general with COVID-19. We sought to rapidly implement a system for multi-center data collection on pediatric HTx candidates and recipients, with the aim of describing the patient population and infection related outcomes. METHODS: The Pediatric Heart Transplant Society (PHTS) is a multi-center collaboration that seeks to improve the outcomes of children who are listed and undergo HTx. The society consists of pediatric HTx centers in North America (n = 53), UK (n = 2), and Brazil (n = 1). In response to the pandemic, PHTS developed a web-based platform to collect COVID-19 specific data on pediatric HTx candidates and recipients. Non-PHTS centers were also invited to submit data. Data fields included pre-and post-HTx patient characteristics, presumed versus documented infection, need for hospitalization (including ICU and ventilator use), treatments administered, and 30-day outcome (resolution, death, sequelae, and or unresolved) RESULTS: Data collection was initiated on 4/30/20. As of 03/15/21 there were 225 patients [19 pre-HTx and 206 post-HTx, median age 14 years (IQR 7, 18)] reported from 41 centers. Hospitalization occurred in 42% (n = 8) of the pre-HTx and 21% (n=43) of the post-HTx patients. Among the patients listed for HTx, 21% (n = 4) required ICU and 10.5% (n = 2) were mechanically ventilated. Among post-HTx patients, 7% (n = 14) required ICU and 1% (n = 3) were mechanically ventilated. At 30 days, the majority of patients had resolution of symptoms (94.7% pre-HTx, 95.6% post-HTx). One death was reported in a post-HTx patient prior to 30 days from onset of COVID-19 illness. CONCLUSIONS: These data demonstrate the ability to rapidly adapt the PHTS data collection infrastructure in response to a novel infection and represent the first known multi-center report of characteristics and early outcomes for patients listed and following pediatric HTx with COVID-19. Hospitalization appears to be more common for both candidates and recipients due to COVID-19 than for the general pediatric population though stays were short and mortality minimal.

Stream Physical Characteristics Impact Habitat Quality for Pacific Salmon in Two Temperate Coastal Watersheds.

Climate warming is likely to cause both indirect and direct impacts on the biophysical properties of stream ecosystems especially in regions that support societally important fish species such as Pacific salmon. We studied the seasonal variability and interaction between stream temperature and DO in a low-gradient, forested stream and a glacial-fed stream in coastal southeast Alaska to assess how these key physical parameters impact freshwater habitat quality for salmon. We also use multiple regression analysis to evaluate how discharge and air temperature influence the seasonal patterns in stream temperature and DO. Mean daily stream temperature ranged from 1.1 to 16.4°C in non-glacial Peterson Creek but only 1.0 to 8.8°C in glacial-fed Cowee Creek, reflecting the strong moderating influence glacier meltwater had on stream temperature. Peterson Creek had mean daily DO concentrations ranging from 3.8 to 14.1 mg L(-1) suggesting future climate changes could result in an even greater depletion in DO. Mean daily stream temperature strongly controlled mean daily DO in both Peterson (R2=0.82, P<0.01) and Cowee Creek (R2=0.93, P<0.01). However, DO in Peterson Creek was mildly related to stream temperature (R2=0.15, P<0.01) and strongly influenced by discharge (R2=0.46, P<0.01) on days when stream temperature exceeded 10°C. Moreover, Peterson Creek had DO values that were particularly low (<5.0 mg L(-1)) on days when discharge was low but also when spawning salmon were abundant. Our results demonstrate the complexity of stream temperature and DO regimes in coastal temperate watersheds and highlight the need for watershed managers to move towards multi-factor risk assessment of potential habitat quality for salmon rather than single factor assessments alone.