Short-term complications and post-acute sequelae in hospitalized paediatric patients with COVID-19 and obesity: A multicenter cohort study.

BACKGROUND: Obesity increases the severity of coronavirus disease 2019 illness in adults. The role of obesity in short-term complications and post-acute sequelae in children is not well defined. OBJECTIVE: To evaluate the relationship between obesity and short-term complications and post-acute sequelae of SARS-CoV-2 infection in hospitalized paediatric patients. METHODS: An observational study was conducted in three tertiary hospitals, including paediatric hospitalized patients with a confirmatory SARS-CoV-2 RT-PCR from March 2020 to December 2021. Obesity was defined according to WHO 2006 (0-2 years) and CDC 2000 (2-20 years) growth references. Short-term outcomes were intensive care unit admission, ventilatory support, superinfections, acute kidney injury, and mortality. Neurological, respiratory, and cardiological symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms were considered as post-acute sequalae. Adjusted linear, logistic regression and generalized estimating equations models were performed. RESULTS: A total of 216 individuals were included, and 67 (31.02%) of them had obesity. Obesity was associated with intensive care unit admission (aOR = 5.63, CI95% 2.90-10.94), oxygen requirement (aOR = 2.77, CI95% 1.36-5.63), non-invasive ventilatory support (aOR = 6.81, CI95% 2.11-22.04), overall superinfections (aOR = 3.02 CI95% 1.45-6.31), and suspected bacterial pneumonia (aOR = 3.00 CI95% 1.44-6.23). For post-acute sequalae, obesity was associated with dyspnea (aOR = 9.91 CI95% 1.92-51.10) and muscle weakness (aOR = 20.04 CI95% 2.50-160.65). CONCLUSIONS: In paediatric hospitalized patients with COVID-19, severe short-term outcomes and post-acute sequelae are associated with obesity. Recognizing obesity as a key comorbidity is essential to develop targeted strategies for prevention of COVID-19 complications in children.

Should systemic corticosteroids be used for bronchiolitis? / ¿Deben utilizarse corticoides sistémicos en la bronquiolitis?

INTRODUCTION: Bronchiolitis is an acute small airways inflammation mainly caused by a viral infection. It is frequent in children under two years of age, particularly under 12 months. The use of systemic corticosteroids has been proposed for bronchiolitis, especially for severely ill patients. However, its efficacy is still controversial. METHODS: To answer this question we gathered information using Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data from primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews, including 20 randomized trials overall. We concluded the use of systemic corticosteroids has no benefit for the treatment of bronchiolitis, even for patients with mechanical ventilation.

INTRODUCCIÓN: La bronquiolitis es una inflamación aguda de las vías aéreas pequeñas debida principalmente a una infección viral. Es una patología frecuente en menores de dos años y en especial en menores de 12 meses. Se ha propuesto el uso de corticoides sistémicos en bronquiolitis, en especial en pacientes de mayor severidad, siendo controversial su utilidad. MÉTODOS: Para evaluarlo utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 20 ensayos aleatorizados. Concluimos que el uso de corticoides sistémicos no aporta ningún beneficio en el tratamiento de la bronquiolitis, aún en pacientes con ventilación mecánica.

Do inhaled corticosteroids have a role for bronchiolitis? / ¿Tienen los corticoides inhalatorios un rol en la bronquiolitis?

INTRODUCTION: Bronchiolitis consists of an acute small airways inflammation secondary to a viral infection and is a frequent pathology among children under 2 years. The use of inhaled corticosteroids during bronchiolitis has been proposed to reduce recurrent wheeze or asthma, however there is controversy about it. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including 11 randomized trials. We concluded that inhaled corticosteroids do not reduce recurrent wheeze or asthma in patients with bronchiolitis.

INTRODUCCIÓN: La bronquiolitis corresponde a una inflamación aguda de las vías aéreas pequeñas secundaria a infección viral y es una patología frecuente en menores de dos años. Se ha propuesto que el uso de corticoides inhalatorios durante una bronquiolitis podría reducir la recurrencia de sibilancias o el desarrollo de asma, sin embargo, existe controversia al respecto. MÉTODOS: Para responder a esta interrogante utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyen 11 ensayos aleatorizados. Concluimos que el uso de corticoides inhalatorios no reduce la recurrencia de sibilancias o asma en pacientes con bronquiolitis.

Are systemic corticosteroids useful for the management of acute pharyngitis? / ¿Son útiles los corticoides sistémicos en el manejo de la faringitis aguda?

INTRODUCTION: Pain associated to acute pharyngitis is a frequent cause of consultation. Usual care includes non-steroidal anti-inflammatories and antibiotics in selected cases, but pain relief is not always quick enough. The use of corticosteroids has been proposed as a therapeutic alternative, but its actual efficacy is matter of debate. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 11 studies overall, of which 10 were randomized trials. We concluded a short course of systemic corticosteroids reduces pain related to acute pharyngitis, without increasing the risk of adverse effects.

INTRODUCCIÓN: La faringitis aguda constituye un motivo de consulta frecuente, en especial por el dolor asociado a ésta. El manejo habitual incluye antiinflamatorios no esteroidales y antibióticos en casos seleccionados, pero el alivio del dolor no siempre se consigue de manera rápida. Se ha planteado el uso de corticoides como alternativa terapéutica, pero existe controversia al respecto. MÉTODOS: Utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 11 estudios primarios, entre ellos 10 ensayos aleatorizados. Concluimos que el uso de corticoides sistémicos en cursos cortos reduce el dolor asociado a la faringitis aguda, sin aumentar el riesgo de efectos adversos.