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The global pandemic of coronavirus disease 2019 (COVID-19) has brought great challenges to the traditional medical model. During the outbreak of COVID-19 in Shanghai, China, from March to May, 2022, there was a significant increase in the number of pediatric cases due to high transmissibility, immune escape, and vaccine breakthrough capacity of Omicron variants. The designated hospitals for children with COVID-19 served as a connecting link between children's specialized hospitals and mobile cabin hospitals. From April 7 to June 2, 2022, a total of 871 children with COVID-19 were admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine (South Branch), a designated hospital for children with COVID-19. Among these patients, 568 (65.2%) were children under 3 years old, 870 (99.9%) were mild or moderate, and 1 was severe. This article reports the experience in the management of pediatric cases in this designated hospital, which included the following aspects: establishing an optimal case-admission process; strengthening multidisciplinary standardized diagnosis and treatment; optimizing the management, warning, and rescue system for severe COVID-19; implementing family-centered nursing care; formulating an individualized traditional Chinese medicine treatment regimen; optimizing the discharge process and strengthening bed turnover; implementing strict whole-process control to reduce the risk of nosocomial infection; constructing a structured medical record system and using information platforms to adapt to the work mode of large-volume cases; conducting scientific research and sharing the experience in diagnosis and treatment.

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys.

BACKGROUND: Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. METHODS: Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children's Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. RESULTS: A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. CONCLUSIONS: Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.

[Clinical characteristics of refractory Mycoplasma pneumoniae pneumonia in children].

OBJECTIVE: To provide a basis for early diagnosis and treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children by comparing the clinical characteristics of RMPP and general Mycoplasma pneumoniae pneumonia (MPP). METHODS: Children with MPP hospitalized between October 2015 and December 2016 were selected as study subjects. According to the diagnostic criteria, children were divided into RMPP group (n=152) and MPP group (n=551). The differences between the two groups in the basic situation, clinical manifestations, infection parameters and myocardial enzymes were compared. RESULTS: There were no significant differences in gender and age between the RMPP and MPP groups (P>0.05). The peak temperature in the RMPP group was significantly higher than that in the MPP group on the first day of admission (P<0.01). The percentage of children with augmentation in the RMPP group was lower than that in the MPP group (P=0.009). The percentage of neutrophils [Ne(%)] and serum procalcitonin (PCT) levels in the RMPP group were both higher than those in the MPP group (P<0.05), while the percentage of lymphocytes was significantly lower in the RMPP group (P<0.05). The serum levels of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in the RMPP group were also higher than those in the MPP group (P<0.05). Binary logistic regression analysis showed that the peak temperature and LDH were closely related to RMPP in children (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the peak temperature and LDH for the diagnosis of RMPP was 0.647 and 0.637 respectively. In children ≤2 years old, when the threshold value of LDH was 400 U/L, the diagnostic sensitivity was 52.63% and the specificity was 54.84%. In children above 2 years old, when the threshold value of LDH was 335 U/L, the diagnostic sensitivity was 69.92% and the specificity was 51.55%. CONCLUSIONS: The children with RMPP have a high fever in the early stage. Meanwhile there are abnormal laboratory test results in these children. Elevated serum LDH levels have a high clinical value of early diagnosis of RMPP, especially in children above 2 years.

[Distribution of pathogenic microorganisms and its relationship with clinical features in children with community-acquired pneumonia].

OBJECTIVE: To study the distribution of pathogenic microorganisms in different genders, age groups and seasons in children with community-acquired pneumonia (CAP) and the relationship between the distribution of pathogenic microorganisms and clinical features. METHODS: A total of 1,155 children with CAP were enrolled, among whom there were 670 boys and 485 girls, with a mean age of 3.1±2.8 years (range: one month to 14 years). Indirect immunofluorescence assay, particle agglutination test, enzyme-linked immunosorbent assay, colloidal gold method. and bacterial culture were applied to determine common respiratory pathogenic microorganisms in sputum, throat swabs, blood samples, bronchoalveolar lavage fluid, and urine. RESULTS: A total of 758 specimens (65.63%) were tested positive by pathogen detection. The top three dominant pathogens were Mycoplasma pneumoniae (MP, 43.64%), bacteria (15.12%), and respiratory syncytial virus (RSV, 9.26%), and the rate of mixed infection was 16.02%. The rates of MP infection between boys and girls with CAP were different (40.8% vs 47.6%; P<0.05). The MP detection rate was the highest in the age group of 6-14 years (77.4%) and the lowest in children younger than 1 year (11.2%), while the detection rates of bacteria and RSV were the highest in children younger than 1 year (21.2% and 17.2%, respectively). The MP detection rate was significantly higher in summer and autumn than in winter and spring, while the detection rates of bacteria and RSV in summer and autumn were significantly lower than those in winter and spring. Among children who were MP positive, fever, chills, cough, crackles were more likely to appear; children with RSV infection were more likely to have wheezes; children with bacterial infection were less likely to have cough. Serum levels of C-reactive protein and procalcitonin were associated with bacterial infection (OR=1.747 and 1.418, respectively; both P<0.05). CONCLUSIONS: MP plays a more and more important role in the pathogenic microorganisms of CAP in children. Prevalence and outbreaks of MP infection among children should be alerted in summer and autumn. There are differences in the detection rate of various pathogenic microorganisms in CAP children with various age groups. The clinical features of children with CAP caused by different pathogenic microorganisms are different.