Nirsevimab immunization's real-world effectiveness in preventing severe bronchiolitis: A test-negative case-control study.

BACKGROUND: Several clinical trials have shown that nirsevimab, an antibody targeting the respiratory syncytial virus (RSV), reduces RSV bronchiolitis requiring admission. In 2023-2024, Catalonia and Andorra adopted immunization strategies for children <6 months and those born during the epidemic season. This study evaluates the effectiveness of nirsevimab in preventing hospitalizations from RSV bronchiolitis. METHODS: In the epidemic season of 2023-2024, a test-negative case-control study was conducted in three hospitals from Catalonia and Andorra. Patients <12 months old admitted with bronchiolitis and tested for RSV using molecular microbiology tests were included. The effectiveness in preventing RSV bronchiolitis hospitalization and severe disease was estimated using multivariate models. Comparisons between immunized, non-immunized, and non-eligible patients were made in prospectively collected epidemiological, clinical, and microbiological variables. RESULTS: Two hundred thirty-four patients were included. RSV was detected in 141/234 (60.2%), being less common in the immunized group (37% vs 75%, p < .001). The rate of immunized patients among those eligible was 59.7%. The estimated effectiveness for RSV-associated lower respiratory tract infection was 81.0% (95% confidence interval: 60.9-90.7), and for preventing severe disease (the need for NIV/CMV), 85.6% (41.7-96.4%). No significant differences by immunization status were observed in patients with RSV concerning viral coinfections, the need for NIV/CMV or length of hospital stay. CONCLUSIONS: This study provides real-world evidence of the effectiveness of nirsevimab in preventing RSV-lower respiratory tract infection hospitalization and severe disease in infants during their first RSV season following a systematic immunization program. Immunized patients did not exhibit a higher rate of viral coinfections nor differences in clinical severity once admitted.

Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain.

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).  Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.

Comparing infant and toddler sleep patterns prior to and during the first wave of home confinement due to COVID-19 in Spain.

Recent literature has shown that sleep patterns are shaped during the first years of life, playing a relevant role in children's functioning. We focused on comparing sleep patterns in infants and toddlers in Spain before and during COVID-19 home confinement to assess the immediate impact on sleep patterns. We compared data from two cross-sectional surveys from parents of 1658 children three to 36 months of age from Spain. One conducted before COVID-19 (2017-2018, n = 1380) and another during COVID-19 pandemic (March-May of 2020, n = 254). We used an internet self-administrated questionnaire using the Brief Infant Sleep Questionnaire (BISQ) criteria in both surveys. During confinement, infants and toddlers went to sleep later (median bedtime 21:30 before confinement vs. 21:36 during confinement (p = 0.004)). More infants and toddlers showed longer sleep latencies (> 30 min) during confinement median 33.9% versus 12.3% (p < 0.001). Based on the recommended BISQ criteria, we observed an increase in poor sleepers meeting at least one criterion of inadequate patterns during confinement (p < 0.001). Parental perception of a child's sleep as problematics were 39.4% and 44.1% (adjusted p = 0.363) before and under lockdown, respectively. CONCLUSION: Home confinement generally affected infant's and toddler's sleep patterns negatively; however, parents did not report worse perception of sleep quality of their children. Follow-up studies can help understand the potential long-term effects of the COVID-19 pandemic on sleep patterns. WHAT IS KNOWN: • Adequate sleep patterns in infants and toddlers are relevant as they are linked to proper and long-term social-emotional development as well as adequate daytime functioning. • Regarding sleep patterns in paediatrics during the COVID pandemic, recent literature has described an increase in total daily sleep time as well as more exposure to screens in children and adolescents, providing evidence of immediate collateral consequences of the COVID-19 outbreak. WHAT IS NEW: • Comparing sleep patterns in two samples of infants and toddlers in Spain before and during COVID-confinement, we found later bedtimes as well as a significant increase in infants' and toddlers' sleep latency by >30 min during confinement. • Parental self-reported questionnaire during COVID-19 home confinement reported an overall worsening of their children's sleep based on the BISQ criteria.

Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey.

In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group's hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.

Mitochondrial diseases mimicking neurotransmitter defects.

OBJECTIVES: Mitochondrial disorders are clinically heterogeneous. We aimed to describe 5 patients who presented with a clinical picture suggestive of primary neurotransmitter defects but who finally fulfilled diagnostic criteria for mitochondrial disease. METHODS: We report detailed clinical features, brain magnetic resonance findings and biochemical studies, including cerebrospinal fluid (CSF) biogenic amine and pterin measurements, respiratory chain enzyme activity, and molecular studies. RESULTS: The 5 patients had a very early onset age (from 1 day to 3 months) and a severe clinical course. They all showed a clinical picture suggestive of infantile hypokinetic-rigid syndrome (hypokinesia, hypomimia, slowness of reactions, tremor), other abnormal movements (myoclonus, dystonia), axial hypotonia, limb hypertonia, feeding difficulties, and psychomotor delay. Abnormal CSF findings among the 4 patients without treatment included low levels of homovanillic acid (HVA) in 3 patients, with associated low 5-hydroxyindoleacetic acid (5-HIAA) concentrations in two of them. Absent or mild and transitory improvement was observed after treatment with L-dopa. A diagnosis of mitochondrial disorder was finally made due to the appearance of hyperlactacidemia, diverse respiratory chain defects, and multisystemic involvement. CONCLUSIONS: Secondary neurotransmitter disturbances may occur in mitochondrial diseases. Differential diagnosis of hypokinetic-rigid syndrome presenting in infancy could also include paediatric mitochondrial disorders.

Características clínicas y epidemiológicas de niños con infección por gripe A (H1N1) 2009 / Clinical and epidemiological characteristics of children with 2009 influenza A (H1N1) infection

Fundamento. El virus pandémico H1N1 ha causado patología grave en personas previamente sanas de mediana edad. La incidencia de infección por H1N1 fue muy superior entre los niños de 5 a 14 años si se compara con otros grupos y si se compara con la gripe estacional. Objetivo. Describir las características de los pacientes con diagnóstico de infección por el virus influenza A (H1N1) 2009. Característiques clíniques i epidemiològiques de nens amb infecció per grip A (H1N1) 2009 María Araceli Caballero Rabasco 1, Mireia Tirado Capistros 2, Adela Retana Castán 2, Pere Sala Castellví 3, Valentí Pineda Solas 4, Antoni Martínez-Roig 1 1 Servei de Pediatria. Hospital del Mar. Parc de Salut Mar. Barcelona. 2 Servei de Pediatria. Hospital de Sant Pau. Barcelona. 3 Servei de Pediatria. Hospital de Barcelona. Barcelona. 4 Servei de Pediatria. Hospital de Sabadell, Corporació Sanitària Parc Taulí. Sabadell Método. Se realiza estudio retrospectivo, descriptivo, mediante revisión de historias clínicas de una cohorte de niños con infección respiratoria aguda y/o síndrome gripal con confirmación de infección por H1N1. Resultados. Un total de 202 pacientes fueron identificados, la media de edad fue de 7,29 años. 55,4% fueron niños y 44,6% fueron niñas. En el 41% de los casos había antecedentes de riesgo. El síntoma clínico más prevalente fue la fiebre (95,5%) seguido de tos (76,7%) y rinorrea (48,5%). La coinfección bacteriana se confirmó en el 8,9%. El patrón intersticial fue el hallazgo radiológico más frecuente (38%). El 39,1% recibieron tratamiento antiviral. El 9,4% ingresaron en la unidad de cuidados intensivos (UCI), la mayoría de ellos con patología previa, y un 1,5% murieron. Conclusiones. En la gran mayoría de los casos, procedentes de un grupo de población con escasos antecedentes de riesgo, cursaron con un cuadro clínico leve con respuesta adecuada a tratamiento sintomático como en la gripe estacional. La coinfección neumocócica estuvo íntimamente relacionada con evolución tórpida y la mayoría de los pacientes que requirieron atención en UCI presentaban patología de base previa(AU)

Background. The 2009 H1N1 pandemic caused severe disease in previously healthy middle-aged individuals. The incidence of H1N1 infection was much higher among children 5 to 14 years old when compared with other age groups and with seasonal influenza A infection. Objective. To describe the characteristics of patients with 2009 influenza A (H1N1) infection. Method. Retrospective study with review of medical records of a cohort of children with acute respiratory infection and/or flu symptoms with confirmation of H1N1 infection. Results. A total of 202 patients (55.4% males) were identified. Mean age was 7.29 years. Risk factors were present in 41% of the cases. The most prevalent clinical symptom was fever (95.5%), followed by cough (76.7%), and rhinorrhea (48.5%). Bacterial coinfection was confirmed in 8.9% of the patients. Interstitial lung disease was the most common radiological finding (38%). Antiviral treatment was administered to 39.1% of the children; 9.4% of children were admitted to the intensive care unit, most of them with pre-existing conditions, and 1.5% of children died. Conclusions. H1N1 infection affected mostly children with low-risk factors, and patients presented with mild clinical symptoms that responded well to symptomatic treatment as it is given for seasonal flu. Pneumococcal co-infection was closely related to protracted evolution; most patients that required intensive care had underlying morbidities(AU)

Anemia y enfermedad celiaca en una paciente con síndrome de Down / Anaemia and celiac disease in a patient with Down syndrome

Las personas con síndrome de Down (SD) tienen más probabilidades de presentar enfermedad celiaca (EC) que la población general. Se presenta un caso de EC que se manifiesta con anemia importante, en una chica adolescente con SD. Paciente de sexo femenino de 13 años de edad, con SD, que ingresa por anemia acompañada de astenia, anorexia y alteración del ritmo intestinal de unas 4 semanas de evolución. Tiene antecedentes de menstruaciones abundantes y algún vómito antes del inicio de la enfermedad actual. Al constatarse la palidez cutánea sele practica analítica y ésta indica una importante anemia, con cifra de hemoglobina de 4,7 g/dL, por lo que la paciente es derivada al hospital. La exploración física muestra una frecuencia cardiaca de 106xminuto,tensión arterial de 112/48 mmHg, palidez cutánea y de mucosas y soplo sistólico. La anemia es normocítica hipocroma y con ferropenia. Los estudios de imagen descartan patología hemorrágica gastrointestinal. El estudio de médula ósea también es normal. Se inicia tratamiento con sulfato ferroso por vía oral. Un mes después, la paciente vuelve a ingresar por dolor abdominal, vómitos y diarrea. Durante el ingreso se practican determinación de anticuerpos antiendomisio y antitransglutaminasa tisular, que resultan positivos. La biopsia intestinal confirma EC. Se instaura una dieta sin gluten y se mantiene el tratamiento con hierro, tras lo cual sigue una evolución favorable y recuperación dela anemia. Hay autores e instituciones que recomiendan la práctica de cribado de EC en personas asintomáticas con SD. En cualquier caso, en las que presentan sintomatología gastrointestinal o de otros tipos –como puede ser una anemia no explicable por otros motivos–, debe descartarse la posibilidad de EC (AU)

Down syndrome (DS) is associated with an increase drisk of celiac disease (CD) than that found ingeneral population. An adolescent girl with DS and CD presenting with severe anaemia is reported. A 13 year-old girl was admitted to hospital for anaemia and a 4 week-history of asthenia, anorexia, and disturbed bowel habit. Her past medical history was remarkable for hypermenorrhea and occasional vomiting. Heart rate was 106xminute and blood pressure112/48 mmHg. On physical exam she was pale and a systolic murmur was heard. Blood tests depicted a severe hypochromic normocytic anaemia with haemoglobin values of 4,7 g/dL Gastrointestinal bleeding was ruled out on the basis of several image studies and a bone marrow study was also normal. Iron supplement with ferrous sulphate was prescribed. A month later she was readmitted to hospital for abdominal pain, vomiting and diarrhoea. Serum endomysium antibodies and tissue transglutaminase antibodies were found to be positive and an intestinal biopsy confirmed the diagnosis of CD. She was started on a gluten-free diet and the iron supplement was maintained. She subsequently followed a favourable clinical course with cessation of gastrointestinal symptoms and correction of the manaemia. Several authors have suggested that people with DS should be routinely screened for CD even if they area symptomatic. Moreover, the existence of CD should be specially considered in people with DS who present with gastrointestinal symptoms or anaemia of unclear etiologies (AU)