The comparison of COVID-19 vs seasonal influenza in children.

BACKGROUND: Influenza in children has been well described, whereas there has been a paucity of pediatric data regarding COVID-19. It is crucial for clinicians to differentiate cases of COVID-19 from cases of influenza because of the upcoming influenza season in the new pandemic era. METHODS: This retrospective study included pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March and September 2020, or seasonal influenza between October 2019 and March 2020. RESULTS: A total of 315 children were included in this study; 151 were diagnosed with influenza and 164 had confirmed COVID-19. The median age of patients with COVID-19 was 10 years (interquartile range [IQR]: 3-15 years), whereas the median age of patients with influenza was 4 years (IQR: 1-6 years) (p = 0.001). In the COVID-19 group, 6.3% of patients had underlying diseases, the most frequent being neurological conditions (3%). In the influenza group, 20.9% of patients had an underlying disease, the most frequent being asthma (14.5%). Fever (odds ratio [OR]: 20.476; 95% confidence interval [CI]: 2.438-171.995; p = 0.005), dyspnea/tachypnea (OR 13.950; 95% CI: 2.607-74.634; p = 0.002), and increased C-reactive protein (CRP) (OR: 7.650; 95% CI: 2.094-27.955; p = 0.002) were main predictors of influenza diagnosis in comparison to COVID-19. Lymphopenia was detected in 43.2% of patients with influenza and 19.9% of patients with COVID-19 (p = 0.001). CONCLUSIONS: The accurate differentiation between "influenza or COVID-19" seems possible by evaluating a combination of factors including cough, fever, vomiting, leucopenia, lymphopenia, pneumonia, in pediatric patients with high CRP as well as age.

Role of Serum Endocan Levels in Children with Bacterial and Viral Pneumonia: A Prospective, Case-Control Study.

Introduction and Objective: Endocan has been used as a biomarker in the differential diagnosis of pulmonary diseases in adults. However, there are only a limited number of studies on its use in children. In this context, the objective of this study is to evaluate the relationship between serum endocan levels in children with bacterial and viral pneumonia. Materials and Methods: The population of this prospective case-control study consisted of hospitalized children aged 1 month to 15 years diagnosed with pneumonia between August 2020 and July 2021, whereas the control group consisted of randomly selected healthy children. The demographic and clinical characteristics of all participants were recorded. Participants' endocan levels, white blood cell (WBC) and neutrophil counts, and C-reactive protein (CRP) and procalcitonin (PCT) levels were measured within the scope of the laboratory tests. Results: The study sample consisted of 41 children, of whom 21 had bacterial pneumonia and 20 had viral pneumonia, whereas the control group consisted of 47 healthy children. Serum endocan levels, WBC and neutrophil counts, and PCT and CRP levels were significantly higher in children with bacterial pneumonia than in children with viral pneumonia and healthy children (P < 0.05). Additionally, serum endocan levels were significantly higher in children with viral pneumonia than in healthy children (P < 0.001). The endocan levels in children with bacterial pneumonia were significantly associated with the need for intensive care (P = 0.004) and correlated with the length of hospital stay (LoS) (r = 0.592, P = 0.005). Conclusion: The findings of this study indicated that serum endocan levels can be used in the differential diagnosis of bacterial and viral pneumonias. Additionally, it was found that the need for intensive care and LoS were significantly correlated with endocan levels in children with bacterial pneumonia.

COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases.

BACKGROUND: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. METHODS: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. RESULTS: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU. CONCLUSION: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.

Evaluation of spontaneous reduction among the invagination cases admitted to the paediatric emergency department; retrospective study.

AIMS: We aimed to determine the factors that determine the conditions in cases of invagination with spontaneous reduction. METHODS: Study was conducted retrospectively in the Paediatric Emergency Department (PED) of the tertiary University Hospital in Ankara, Turkey. Invagination cases admitted between January 1, 2019 and December 31, 2019 were included in the study. Patient information (demographic data such as age, gender, physical examination findings, laboratory and imaging methods, treatment and follow-up) were recorded on the data form prepared by the researchers before the study, using patient files and hospital patient information system. Data were analysed with IBM SPSS V23. RESULTS: During the study period, the number of cases who applied to the PED was 33,849 and 74 of these cases were diagnosed with invagination. In the cases diagnosed with invagination, 69 (93%) of them spontaneously reduced during the follow-up. Among all cases, the male sex ratio was 56.5% (39/69). The average age was 44.6 months (minimum: 6; maximum: 154). The mean follow-up time in the emergency room was 12 hours and in the hospital service was 38 hours. Vomiting was observed in 89.9% (58/69) of all cases, abdominal pain in 68.1% (44/69) and rectal bleeding in 1.4% (1/69).The invagination of 21.7% (15/69) of the patients at the first USG was ileo-ileal. 63.8% (44/69) of the patients were discharged after followed up in emergency observation. The number of USGs was lower in the group that was discharged after the follow-up in the emergency room, than the follow-up groups in the service monitoring (P = .012). CONCLUSION: Invagination is one of the surgical emergencies. With the widespread use of USG, most of these cases are followed up by clinical and USG follow-up in paediatric emergency services. Spontaneous reduction frequently develops in cases of intussusception with small bowel localisation and short bowel segment (less than 3 cm).

The impact of the COVID-19 pandemic on paediatric emergency service.

AIMS: The aims of this research were to review patients visiting the paediatric emergency department over a 6-month period 1 year before and during the pandemic, to review paediatric emergency department referral ratios and to determine whether there were any significant decreases in mortality and morbidity. METHODS: All patients from the ages of 0 to 18 years visiting the University of Health Sciences, Ankara Research and Training Hospital, paediatric emergency service from April-October 2019 to April-October 2020 with no missing information in their records were involved in this retrospective cross-sectional study. RESULTS: The total number of paediatric emergency service consultations was 74 739; the number of emergency visits from April to October 2019 was 55 678, whereas it was 19 061 from April to October 2020 in the midst of the COVID-19 pandemic period. There was a 67.7% decrease in consultations during the pandemic period. The mean age of participants from April to October 2019 was 8.11 ± 5.31 years, and 52.4% of cases were male. The mean age from April to October 2020 was 8.58 ± 5.93 years, and 51% of cases were male. COVID-19-related symptoms were higher during the pandemic period (P < .05), with fever and gastroenteritis being the most frequently received diagnosis in both periods. During the pandemic period, the newborn consultation ratio was higher (P > .05), there was a decrease in consultation ratios related to suicide attempts (P < .05), and a threefold increase in death rates was observed (P < .05). CONCLUSION: In Turkey, where emergency consultation rates are quite high, these decreases look fearsome for secondary injuries that can develop in children. For this reason, families should be made aware of the importance of bringing their children to the hospital during emergencies, and that all necessary health precautions are being taken to decrease the spread of infection in hospitals.

Evaluation of the effect of the COVID-19 pandemic on sleep disorders and nutrition in children.

AIMS: The aim of the study was to evaluate the possible changes in sleep behavior and nutrition in children during the pandemic period. METHODS: One hundred fourteen parents who accepted to participate in the study aged 18 and over and who had children between the ages of 6 and 16 were included in the study. A questionnaire was carried out after written consents were obtained. In the first part of the questionnaire, there were a total of 9 questions including socio-demographic information and nutritional characteristics, and the second part included the "Sleep Disturbance Scale for Children" (SDSC). The data were analyzed with the SPSS 20 statistical program. RESULTS: The total number of participants was 114 parents; 64 (56%) of the children were girls and 50 (43.9%) were boys. Among the participants, the number of children who had COVID-19 was 38 (33.3%). There was no statistically significant relationship between going through COVID-19 status and the variables examined in general. The proportion of participants who stated that if the pandemic period was prolonged, COVID-19 would not change their diet was found to be statistically significant (P = .038). The SDSC score was found to be significantly high in girls (P < .05). CONCLUSION: Sleep and nutritional disorders affect the quality of life for all ages for both genders, and their importance increases even more in extraordinary periods such as pandemic. Sleep problems increasing especially with an accompanying anxiety state may lead to developmental problems as well as deepening psychological disorders.

Nebulized Ipratropium Bromide-induced Anisocoria: Why Is Anisocoria Observed?

Pharmacological anisocoria is a rare but benign condition. This paper presents an eleven-year-old patient with asthma who developed ipratropium bromide-associated anisocoria during nebulizer treatment. Hypotheses regarding the possible causes of anisocoria are discussed and precautions to be taken during treatment are presented. To prevent the development of anisocoria, it was found that it is important to use the appropriate mask during nebulizer treatment, to place the mask on the face properly, and, if possible, to administer drugs by closing the eyes. Further, it is recommended that patients undergo an ophthalmological examination before discharge and that they and their families be informed that the condition is temporary.

The association of viral load and disease severity in children with COVID-19.

It is still not fully understood how to predict the future prognosis of patients at the diagnosis coronavirus disease 2019 (COVID-19) due to the wide clinical range of the disease. We aimed to evaluate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load could predict the clinical course of pediatric patients. This study was conducted retrospectively with medical records of pediatric patients who were tested for SARS-CoV2 between April 12 and October 25, 2020 in the University of Health Sciences, Ankara Educating and Training Hospital and Hacettepe University Faculty of Medicine. We evaluated 518 pediatric patients diagnosed with COVID-19 and classified according to severity as asymptomatic (16.2%), mild (59.6%), moderate (20.2%), and critical/severe (3.9%) cases. We analyzed patients in four groups in terms of ages: <4, 5-9, 10-14, and 15-17 years. There was no statistically significant difference in terms of ∆Ct value among age groups, different gender and the existence of underlying diseases in each disease course. The ∆Ct values were relatively lower in the first 2 days of symptoms than after days in all groups. Our study has indicated that children with COVID-19 have similar amount of viral load in all disease courses irrespective of the age and underlying disease. It should be taken into account that, regardless of the severity of the disease, pediatric patients may have a role in the transmission chain.

Successful intraosseous adenosine administration in a newborn infant with supraventricular tachycardia.

BACKGROUND: Supraventricular tachycardia (SVT) is the most common type of tachycardia in childhood. The incidence is 1-4/1000 in childhood and 0.6/1000 in newborns. CASE: Here we report a 28-day-old male newborn who was diagnosed SVT, admitted to the Pediatric Emergency Department after restlessness that had started three hours before admission and measurement of the heart rate was above 250 beats/min. CONCLUSIONS: This case is presented in order to emphasize that SVT is rare in the neonatal period and SVT is successfully terminated with the administration of intraosseous adenosine.