Risk of Urinary Tract Infection and Bacteremia in Infants Infected With COVID-19.

OBJECTIVE: Our objective was to evaluate the risk of urinary tract infection (UTI) and bacteremia in infants 1 year or less of age infected with COVID-19. METHODS: This was a retrospective study from TriNetX database in the United States. This study was from March 11, 2020, to May 11, 2023, during the COVID-19 pandemic. Patients were included if they were infants, 1 year or less, had a fever, and had a COVID-19 polymerase chain reaction test 1 week before or after presentation to the emergency department (ED) or hospital. We compared outcomes of bacteremia and a UTI in those with COVID-19 and those without COVID-19. Propensity matching was done to account for the confounders of age, gender, race, immune disorders, genitourinary abnormalities, preterm birth, and circumcision. RESULTS: Infants who were positive for COVID-19 were at a reduced risk of UTI and bacteremia. There was a significant decreased risk of having a UTI if one had COVID-19 (1.0%) versus those without COVID-19 (2.3%) (risk ratio = 0.37, 95% confidence interval = 0.37-0.50, P < 0.001). For bacteremia, there was also a decreased risk if the infant had COVID-19 (0.4%), versus those without COVID-19 (0.5%) (risk ratio = 0.74, 95% confidence interval = 0.56-0.97, P = 0.03). CONCLUSIONS: Infants with fever found to have COVID-19 had lower risks of UTI and bacteremia.

SARS-CoV-2 and RSV bronchiolitis outcomes.

BACKGROUND: Severe acute respiratory syndrome related coronavirus (SARS-CoV-2) bronchiolitis has arisen with the SARS-CoV-2 pandemic. There is a paucity of literature on SARS-CoV-2 bronchiolitis. OBJECTIVE: The purpose of our paper was to review and compare outcomes in bronchiolitis due to severe acute respiratory syndrome related coronavirus 2 (SARS- CoV-2) and Respiratory Syncytial Virus (RSV). We also performed a subgroup analysis of two disrupted RSV seasons during the pandemic. METHODS: This was a retrospective study from a US TriNetX database from March 1, 2020-January 1, 2023. Propensity matching was utilized for confounders. RESULTS: There was a total of 3,592 patients (1,796 in each group) after propensity matching. There was an increased risk of oxygen saturation ≤95 % (RR=1.50 95 % CI 1.58-1.94, p = 0.002) and ICU admission (RR=1.44 95 % CI 1.06-1.94, p = 0.02) in those with SARS- CoV-2 but not for oxygen saturation ≤90 % (RR=1.03 95 %CI 0.75-1.42, p = 0.85) or intubation (RR=0.73 95 % CI 0.35-1.47, p = 0.37). There was a decreased risk of a patient with SARS- CoV-2 bronchiolitis being hospitalized (RR=0.65 95 % CI 0.57-0.74, p < 0.0001), respiratory rate ≥60 (RR=0.64 95 % CI 0.48-0.88, p < 0.001) or ≥70 (RR=0.64 95 % CI 0.43-0.96, p = 0.03) when compared to RSV bronchiolitis. Specifically examining SARS- CoV-2 versus RSV bronchiolitis during the delayed RSV seasons, during the first season both infections were not severe, but during the second RSV bronchiolitis season, patients infected with RSV had less risk of ICU admission compared to those infected with SARS- CoV-2. CONCLUSION: SARS- CoV-2 bronchiolitis patients appeared to have more severe outcomes since the risk of ICU admission was higher for these patients. Also, during the second delayed RSV season, SARS- CoV-2 bronchiolitis was more severe than RSV bronchiolitis.

Outcomes of croup in children: COVID-19 versus non-COVID-19 cases.

Objectives: The emergence of COVID-19 has revealed its association with croup. The objective of this study was to compare outcomes of COVID-19 related croup to non-COVID-19 related croup during the COVID-19 pandemic. Methods: This retrospective propensity matched study used data from 2020-2023 in the United States Cohort of the TriNetX database that includes 56 major health care organizations. The analysis compared the outcomes of 2 cohorts of patients between 2 months and 7 years of age: Cohort A had croup and a positive test for COVID-19 and Cohort B had croup without a positive COVID-19 test, both within 1 week before or after presentation with croup. Outcomes were death, admission to the hospital, intensive care unit (ICU) admission, respiratory rate >60, and oxygen saturation <90 within 7 days after the diagnosis of croup. Results: There were 2590 patients with COVID-19 related croup and 103,439 patients with non-COVID-19 croup. The final propensity matched cohort included 5180 patients evenly divided between groups. When both groups were compared based on outcomes after matching, there was twice the risk of the patient being admitted to the hospital with COVID-19 croup (risk ratio [RR] = 2.12; 95% confidence interval [CI] 1.59-2.84; P < 0.001). Those with COVID-19 related croup had significantly increased risk of being admitted to the ICU (RR = 4.90; 95% CI 3.11-7.73; P < 0.001). The patients with COVID-19 related croup were more likely to have a respiratory rate ≥60 (RR = 2.00; 95% CI 1.18-3.37; P = 0.008) and oxygen saturation ≤90% (RR = 2.12; 95% CI 1.21-3.70; P = 0.007). There were no deaths in the final cohorts. There were no worse outcomes in the Omicron COVID-19 related croup group. Conclusions: The patients with COVID-19 related croup exhibited more severe disease manifestations. These children were more likely to be admitted to the hospital/ICU and had more significant respiratory distress.

Role of functional echocardiographic parameters in the diagnosis of bronchopulmonary dysplasia-associated pulmonary hypertension.

Echocardiogram (echo) is a commonly used noninvasive modality for the diagnosis of bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH). Though not considered the gold standard for the diagnosis of BPD-PH, it is an extremely valuable tool in the neonatal and pediatric population, especially when cardiac catheterization is not feasible. In addition to the traditional echo parameters that are used to assess the presence of BPD-PH, much attention has been recently placed on newer bedside echo measures, the so-called functional echo parameters, to aid and assist in the diagnosis. This review article provides a brief introduction to BPD-PH, describes the pitfalls of traditional echo parameters and details the newer echo modalities currently available for the diagnosis of neonatal PH.

Diffuse Chorangiomatosis as a Cause of Cardiomegaly, Microangiopathic Hemolytic Anemia and Thrombocytopenia in a Newborn.

INTRODUCTION: The hallmark of diffuse chorangiomatosis is capillary dysvasculogenesis, diffusely involving the placenta. It can cause massive placental enlargement and may have adverse fetal effects. CASE REPORT: A 32 weeks gestation male infant was born via cesarean section and had a placenta weighing 900 g. There was diffuse vascular proliferation involving the stem villi and intermediate villi. Short Nucleotide Polymorphism (SNP) microarray analysis of the placenta showed no biparental mosaicism or loss of heterozygosity, ruling out placental mesenchymal dysplasia. The infant also had cardiomegaly, microangiopathic hemolytic anemia and thrombocytopenia which spontaneously improved over time. CONCLUSION: Diffuse chorangiomatosis can be associated with hemolysis, thrombocytopenia and cardiomegaly in the newborn. However, once delivered, these findings can spontaneously resolve over time.

Hospice care for the incarcerated in the United States: an introduction.

Prison populations throughout the Unites States are growing; the 1990s saw an average 6.5% per year increase. Average inmate age is increasing, as are both the number and rate of inmate deaths. Aging inmates experience health concerns typical of the general, free, aging population. Inmates have higher incidence of health complications associated with various circumstances, risk behaviors, and associated medical conditions. These circumstances include prison violence, incarceration-related constraints on exercise, and diet. Inmates are more likely to have a history of alcohol abuse, substance abuse or addiction and sex industry work. Risk-behavior conditions include human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), hepatitis B and C, liver disease, tuberculosis, endocarditis, and cardiomyopathy. Hospice is increasingly the preferred response to the health and care needs of terminally ill inmates. Implementing hospice behind bars has some unique challenges in addition to those inherent in hospice work. This series will provide an in-depth look at four hospice programs for inmates in the United States.