The prognostic value of C-reactive protein for children with pneumonia.

AIM: To measure the prognostic value of C-reactive protein (CRP) and its ability to predict pneumonia-associated complications. METHODS: A 3.75-years retrospective cohort analysis of all paediatric emergency department visits with a discharge diagnosis of pneumonia. Visits where CRP was not measured or with a discharge diagnosis of viral pneumonia were excluded. The following five outcomes were studied: hospitalisation, presence of parapneumonic effusion (PPE), placement of a chest drain, admission to paediatric intensive care unit (PICU) and bacteremia. A multivariate model was constructed and validated using k-fold cross-validation. RESULTS: During the study time period, there were 2561 visits for pneumonia, of which 810 were included in our analysis. The median age of included children was 3.2 years (range 0.2-17.7). Overall, 38.8% visits ended in hospitalisation, 2.2% required admission to PICU, 15.2% were complicated by a PPE of which 28% required the placement of a chest drain. Statistically significant association was found between CRP levels and each of these outcomes (P < .001). Incorporating CRP within a multivariate prediction model provided an area under the curve of up to 0.96. CONCLUSION: CRP can be a useful prognostic marker when evaluating a patient with suspected bacterial pneumonia and could help the paediatrician in identifying patients needing closer follow-up.

The ongoing indirect effect of the COVID-19 pandemic on a pediatric emergency department.

INTRODUCTION: The SARS-CoV-2 coronavirus pandemic may cause significant morbidity and mortality in adults, yet severe cases are rare among children. The indirect impact of the pandemic on health care delivery in general and pediatric emergency department (PED) visits in particular has been widely reported. AIMS: To assess the impact of the pandemic and the social restrictions imposed in its wake on PED visits and hospitalization rates in our Israeli medical center. We also sought to track these data in relation to the variation in pandemic severity and social restrictions over time. A comparison of this data with that of the adult emergency department was also performed. METHODS: Data for this study were drawn from the Shaare Zedek Medical Center (SZMC), Jerusalem, Israel computerized databank. The daily number of PED and adult ER visits as well as hospitalizations resulting from these visits during the months January-July during the years 2018, 2019, 2020 were recorded. We compared the risk ratio for hospitalization in 2019 and 2020, as well as the incidence rate ratio. RESULTS: During March and April there was a decrease in PED visits from 4,588 visits in 2019 to 2,527 visits in 2020 (ratio = .551, 95%CI [.52,.58]. Despite the drop in PED visits, the rate of hospitalizations rose with respect to 2019 (Risk Ratio = 1.31, p < .001, 95%CI [1.17,1.47]). Similar but more moderate trends were seen in the adult ED. From May-July 2020, after the lockdown was lifted, PED visits remained 30% below the same time period from 2018 and 2019, while the hospitalization rate returned to its pre-pandemic level. CONCLUSIONS: A significant drop in PED visits is seen to extend well beyond the peak of the pandemic and the lockdown period. This highlights the potential risk of children with serious emergencies becoming casualties of the pandemic by their not being brought to medical attention. Efforts should be made to raise public awareness among parents and other caretakers of children regarding this matter.

Complicated community acquired pneumonia in childhood: Different types, clinical course, and outcome.

The incidence of pediatric community acquired complicated pneumonia (PCACP) is increasing. Questions addressed: Are different types of PCACP one disease? How do different treatment protocols affect the outcome? METHODS: Retrospective analysis of medical records of PCACP hospitalizations in the three major hospitals in Jerusalem in the years 2001-2010 for demographics, clinical presentation, management, and outcome. RESULTS: Of the 144 children (51% aged 1-4 years), 91% of Jewish origin; 40% had para-pneumonic effusion (PPE), 40% empyema (EMP), and 20% necrotizing pneumonia (NP). Bacterial origin was identified in 42% (empyema 79%, P = 0.009), most common S. pneumoniae (32%), group A streptococcus (9%). Patients with EMP, compared to PPE and NP, were less likely to receive prior antibiotic treatment (35% vs. 57% and 59%, respectively, P = 0.04). Mean hospitalization was longer in patients with NP followed by EMP and PPE (16.4 ± 10.6, 15.2 ± 7.9, and 12.7 ± 4.7 days, respectively), use of fibrinolysis was not associated with the outcome. All children had recovered to discharge regardless of antibiotic therapy or fibrinolysis. ANSWER: NP is a more severe disease with prolonged morbidity and hospitalization in spite of prior antibiotic treatment. All types had favorable outcome regardless of treatment-protocol. Complicated pneumonia has an ethnic predominance. Pediatr Pulmonol. 2017;52:247-254. © 2016 Wiley Periodicals, Inc.

Parents' compliance with specific medical instructions in newborn discharge letters.

BACKGROUND: Due to decreased hospital stay, follow-up of unresolved medical problems of babies with uncomplicated postpartum course is relegated to outpatient clinics. OBJECTIVE: To identify factors in discharge letters that influence parent compliance. METHODS: Telephone contact with parents three months after discharge queried compliance with routine and special instructions as written in discharge letters. Statistical analyses compared responses of compliant versus less compliant parents. P<0.05 was considered to be statistically significant. The present study was approved by the Institutional Ethical Review Board Committee. RESULTS: Of the 2000 discharge letters, 319 (16%) included special instructions. Parents of 252 infants (79%) who received discharge letters containing 332 special instructions were interviewed by telephone. Compliance was greater for noninvasive instructions (86%) relative to others (57.8%) (P<0.001). Initiation of follow-up visits was correlated with parity (P<0.001) and maternal age (P<0.001). CONCLUSION: Discharge letters should be read and discussed with parents before infants are discharged, and the relevance of specific medical instructions should be emphasized.