RESUMEN
AIM: The immune status of children recovering from SARS-CoV-2 infection is not completely understood. We describe IgG antispike persistence in children infected during the first two pandemic waves. In addition, we compared with healthy controls their leukocyte populations and CD64 expression. METHODS: Cross-sectional study. Carried out from October 2021 to February 2022 in nonreinfected and nonvaccinated children with SARS-CoV-2 in 2020. The presence of antispike IgG was studied using chemiluminescent immunoassay. Leukocyte populations were analysed using flow cytometry and marked for CD45, CD4, CD8 and CD64. Statistical minor than 0.05 was considered significant. RESULTS: One hundred and eighty-three control and 77 patients were included. IgG antispike determinations were performed after a median of 501 days (262-464); 52 of 77 children were positive. Cases showed significantly higher percentages of monocytes, lymphocytes, CD8+ and CD4+ . In addition, CD64 expression was higher in monocytes and neutrophils. The presence of IgG antispike was accompanied by a higher percentage of CD64+ neutrophils. CONCLUSION: In our series, the SARS-CoV-2 IgG antispike protein was usually positive beyond 1 year after infection. Furthermore, leukocyte populations from cases differ from controls, with higher CD64 expression on neutrophils and monocytes. Prospective clinical observations are required to confirm the implications of these findings.
Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Niño , Estudios Prospectivos , Estudios Transversales , Receptores de IgG/genética , Receptores de IgG/metabolismo , Inmunoglobulina G , Anticuerpos AntiviralesRESUMEN
AIM: Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. METHODS: This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. RESULTS: There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. CONCLUSIONS: Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.
Asunto(s)
Asma , Servicios de Atención de Salud a Domicilio , Enfermedad Aguda , Niño , Preescolar , Estudios de Seguimiento , Hospitales , HumanosRESUMEN
BACKGROUND: Cutaneous manifestations in hospitalized children with SARS-CoV-2 have not been studied systematically. OBJECTIVE: To describe the mucocutaneous involvement in pediatric patients with COVID-19 admitted to a pediatric institution in Madrid (Spain), located in a zone reporting among the highest prevalence of COVID-19 in Europe. METHODS: A descriptive, analytical study was conducted on a series of 50 children hospitalized with COVID-19 between March 1, 2020, and November 30, 2020. RESULTS: Twenty-one patients presented with mucocutaneous symptoms: 18 patients with macular and/or papular exanthem, 17 with conjunctival hyperemia, and 9 with red cracked lips or strawberry tongue. Eighteen patients fulfilled criteria for multisystem inflammatory syndrome in children. Patients with mucocutaneous involvement tended to be older and presented to the emergency department with poor general status and extreme tachycardia, higher C-reactive protein and D-dimer levels, and lower lymphocyte counts than patients without skin signs. Mucocutaneous manifestations pose a higher risk of admission to the pediatric intensive care unit (odds ratio, 10.24; 95% confidence interval, 2.23-46.88; P = .003). CONCLUSIONS: Children hospitalized with COVID-19 frequently had mucocutaneous involvement, with most symptoms fulfilling criteria for multisystem inflammatory syndrome in children. Patients with an exanthem or conjunctival hyperemia at admission have a higher probability of pediatric intensive care admission than patients without mucocutaneous symptoms.
Asunto(s)
COVID-19/complicaciones , Enfermedades de la Piel/etiología , COVID-19/diagnóstico , Niño , Preescolar , Femenino , Hospitalización , Humanos , Lactante , Masculino , Membrana Mucosa , Estudios Retrospectivos , Enfermedades de la Piel/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnósticoRESUMEN
Our study describes more than 100 children hospitalized with pneumonia during lockdown in the first pandemic wave with only 20% attributable to SARS-CoV-2. The serologic study during follow-up only helped to detect 4%. Other etiologies were common. Older age, presence of headache, vomiting, lymphopenia and thrombopenia were associated with COVID-19 pneumonia.
Asunto(s)
COVID-19/complicaciones , Pandemias , Neumonía/etiología , SARS-CoV-2/aislamiento & purificación , COVID-19/epidemiología , COVID-19/virología , Niño , Niño Hospitalizado , Preescolar , Femenino , Hospitales Universitarios , Humanos , Lactante , Masculino , Neumonía/epidemiología , Neumonía/virología , SARS-CoV-2/genética , España/epidemiología , Centros de Atención TerciariaRESUMEN
This prospective study evaluated the effects of cisapride on corrected QT interval (QTc) in infants and children. From October 2000 to March 2003 two electrocardiograms (ECG) were obtained for 175 children (ranging in age from 1.5 months to 16.8 years), before and after 15 days of treatment with cisapride (0.2 mg/kg/dose, 3-4 times/day). A single posttreatment ECG was also obtained for 24 patients (ranging in age from 1.5 month to 15.8 years). No statistically significant differences were found between the mean QTc interval before (0.390 [0.018 s]) and after treatment (0.391 [0.018 s]). In patients for whom only a posttreatment ECG recording was performed, mean QTc interval was 0.399 (0.018 s). The QTc interval was never longer than 0.450 s in any of the children. In our experience the use of cisapride at therapeutic doses in infants and children who have no associated risk factors does not significantly prolong QTc interval.
Asunto(s)
Cisaprida/efectos adversos , Electrocardiografía/efectos de los fármacos , Reflujo Gastroesofágico/tratamiento farmacológico , Fármacos Gastrointestinales/efectos adversos , Síndrome de QT Prolongado/inducido químicamente , Adolescente , Distribución por Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Síndrome de QT Prolongado/diagnóstico , Masculino , Estudios Prospectivos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE). PATIENTS AND METHODS: Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures. 198 children received 0.3 % glucosaline solution and in 7 patients, with baseline hypernatraemia, 0.2 % gluco-hyposaline solution was administered. We analysed the results according to whether children were hyponatraemic, normonatraemic or hypernatraemic at presentation. The blood and urine samples were analysed and the concentration of sodium and fractional sodium excretion (EFNa) before and after intervention were considered as outcome measures. RESULTS: The 205 patients included in the study were distributed in 3 groups according to the baseline natraemia results. In 37 cases we detected hyponatraemia (18.04%), in 133 cases isonatraemia (64.87%) and in 35 children hypernatraemia (17.07%). After administering hypotonic fluids we detected a significant difference between initial and final natraemia in all groups; in the group with hyponatraemia, sodium increased and in the groups with iso and hypernatraemia, sodium slightly decreased. A significant correlation between the EFNa and the evolution of natraemia was found. No cases of hyponatraemia post-infusion were seen and there was no correlation between free water administered and natraemia evolution. CONCLUSIONS: RESULTS show that the use of hypotonic fluids does not increase the risk of hospital acquired hyponatraemia in hospitalised children with normal renal function. Our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions.
Asunto(s)
Fluidoterapia/efectos adversos , Gastroenteritis/terapia , Hiponatremia/etiología , Soluciones Hipotónicas/efectos adversos , Enfermedad Aguda , Preescolar , Femenino , Hospitalización , Humanos , Enfermedad Iatrogénica , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Medición de RiesgoRESUMEN
Objetivo: Determinar si la utilización de sueros hipotónicos supone un riesgo en la aparición de hiponatremia iatrogénica en los niños hospitalizados por gastroenteritis aguda (GEA). Pacientes y método: Estudio prospectivo realizado con 205 pacientes de edades comprendidas entre 1 y 28 meses e ingresados con diagnóstico de deshidratación leve o moderada por GEA para recibir sueroterapia en la sección de lactantes de un hospital pediátrico de Madrid (España). El grado de deshidratación inicial se estimó con mediciones clínicas estándar. El suero administrado fue glucosalino 0,3 % en 198 casos y en los 7 casos restantes, todos con hipernatremia inicial, se administró suero glucohiposalino 0,2 %. Se analizó la respuesta a los líquidos intravenosos según si el niño se hallaba normo, hipo o hipernatrémico antes de iniciar el tratamiento. Las cifras de sodio en sangre y la excreción fraccional de sodio (EFNa) se consideraron como medidas de resultado. Resultados: Los 205 pacientes incluidos en el estudio se distribuyeron en tres grupos según el resultado inicial de la natremia. En 37 casos se detectó hiponatremia (18,04 %), en 133 niños isonatremia (64,87 %) y en 35 niños hipernatremia (17,07 %). Después de administrar soluciones hipotónicas encontramos en todos los grupos diferencia significativa entre el sodio sérico inicial y el final; en el grupo con hiponatremia el sodio subió y en los grupos con iso e hipernatremia el sodio descendió ligeramente. Se evidenció correlación significativa entre la EFNa y la evolución de la natremia (Na sérico inicial - Na sérico final). No se detectó ningún caso de hiponatremia posinfusión y tampoco se encontró correlación entre el agua libre administrada y la evolución de la natremia. Conclusiones: En lactantes con funcionamiento renal normal no se ha encontrado hiponatremia como resultado de la administración de sueros hiposalinos intravenosos, hallándose diferencias significativas en la EFNa que indican el ajuste renal de la natremia (AU)
Objective: The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE). Patients and methods: Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures. 198 children received 0.3 % glucosaline solution and in 7 patients, with baseline hypernatraemia, 0.2 % gluco-hyposaline solution was administered. We analysed the results according to whether children were hyponatraemic, normonatraemic or hypernatraemic at presentation. The blood and urine samples were analysed and the concentration of sodium and fractional sodium excretion (EFNa) before and after intervention were considered as outcome measures. Results: The 205 patients included in the study were distributed in 3 groups according to the baseline natraemia results. In 37 cases we detected hyponatraemia (18.04%), in 133 cases isonatraemia (64.87%) and in 35 children hypernatraemia (17.07%). After administering hypotonic fluids we detected a significant difference between initial and final natraemia in all groups; in the group with hyponatraemia, sodium increased and in the groups with iso and hypernatraemia, sodium slightly decreased. A significant correlation between the EFNa and the evolution of natraemia was found. No cases of hyponatraemia post-infusion were seen and there was no correlation between free water administered and natraemia evolution. Conclusions: Results show that the use of hypotonic fluids does not increase the risk of hospital acquired hyponatraemia in hospitalised children with normal renal function. Our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Gastroenteritis/complicaciones , Hiponatremia/prevención & control , Solución Salina Hipertónica/efectos adversos , Estudios Prospectivos , Niño Hospitalizado/estadística & datos numéricos , Fluidoterapia/métodos , Soluciones Hipotónicas/uso terapéuticoRESUMEN
Se valoró de forma prospectiva el efecto en el intervalo QT corregido (QTc) del tratamiento con cisaprida en niños. Desde octubre de 2000 a marzo de 2003, se realizó un electrocardiograma (ECG) basal y otro a los 15 días de tratamiento con cisaprida (o,2 mg/kg/dosis, 3-4 veces/día) a 175 niños (edad entre 1, 5 meses y 15, 8 años). No se encontraron diferencias estadísticamente significativas entre el intervalo QTc medio basal (0, 390 +- 0, 018 s) y postratamiento (0, 391+-0,018 s). En los enfermos con un único ECG postratamineto, el intervalo QTc medio fue de 0, 399+-0,018 s. En ningún caso el intervalo QTc superó los 0,450 s. Según nuestra experiencia, la utilización de cisaprida en dosis terapéticas en niños sin factores de riesgo asociados no prolonga significativamente el intervalo QTc (AU)