Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic.

OBJECTIVES: To compare the clinical profile and short-term outcome of children admitted with acute SARS-CoV-2 infection during the first and second waves of the Coronavirus Disease (COVID-19). METHODS: This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confirmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients' demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. RESULTS: One thousand and twenty-four children were recruited, 592 of the first wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR = 3.38) and neurological manifestations (OR = 4.61). There was a higher requirement of intensive care (OR = 4.2) and invasive mechanical ventilation (OR = 4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the difference was not statistically significant. Children with neurological comorbidities (OR = 8.73), malnutrition (OR = 3.01), and preterm babies (OR = 6.8) were associated with severe COVID. CONCLUSION: The clinical profile of the second wave of COVID-19 in children was different from the first wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a significant increase in the incidence of severe infections requiring ICU care was observed.

Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone.

OBJECTIVE: To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and /or intravenous immunoglobulin (IVIG). METHOD: This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. RESULTS: Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5-9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. CONCLUSIONS: In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.

Safety-pin Induced Hemopericardium and Cardiac Tamponade in an Infant.

BACKGROUND: Safety-pin ingestion causing cardiovascular complications are very rare with high risk for mortality. CASE CHARACTERISTICS: A 10-month-old child who presented with persistent irritability and intermittent fever of 1 month duration. The child had tachypnea and mild subcostal retractions. OBSERVATION: Investigations revealed open safety-pin in lower esophagus, and pericardial effusion that later progressed to cardiac tamponade during handling of the safety pin by endoscope. MESSAGE: It may be safer to drain pericardial collection before handling sharp foreign bodies in lower end of esophagus as it can worsen cardiac complications.