Characteristics and Risk Factors Associated with SARS-CoV-2 Pneumonias in Hospitalized Pediatric Patients: A Pilot Study.

SARS-CoV-2 pneumonia in children has a lower incidence and severity compared to adults. Risk factors are adolescence and comorbidities. Our aims were to describe the characteristics of children admitted with SARS-CoV-2 pneumonia, identify risk factors associated with severity and compare the cases according to the variant of SARS-CoV-2. This was a descriptive and retrospective study, including patients aged 0-18 years hospitalized in a tertiary-care hospital between 1 March 2020 and 1 March 2022. Epidemiological, clinical, diagnostic and therapeutic data were analyzed. Forty-four patients were admitted; twenty-six (59%) were male and twenty-seven (61%) were older than 12 years. Thirty-six (82%) had comorbidities, the most frequent of which were obesity and asthma. Seven (15.9%) patients required high-flow oxygen, eleven (25%) non-invasive ventilation and four (9.1%) conventional mechanical ventilation. In critically ill patients, higher levels of anemia, lymphopenia, procalcitonin, lactate dehydrogenase (LDH) and hypoalbuminemia and lower levels of HDL-cholesterol were detected (all p < 0.05). Prematurity (p = 0.022) was associated with intensive care unit admission. Patients were younger during the Omicron wave (p < 0.01); no variant was associated with greater severity. In conclusion, pediatric patients with a history of prematurity or with anemia, lymphopenia, elevated procalcitonin, elevated LDH levels, hypoalbuminemia and low HDL-cholesterol levels may require admission and present more severe forms. Apart from age, no notable differences between SARS-CoV-2 variant periods were found.

SARS-CoV-2 transmission in teenagers and young adults in Fútbol Club Barcelona's Multidisciplinary Sports Training Academy.

Most studies, aimed at determining the incidence and transmission of SARS-CoV-2 in children and teenagers, have been developed in school settings. Our study conducted surveillance and inferred attack rates focusing on the practice of sports. Prospective and observational study of those attending the sports facilities of Fútbol Club Barcelona (FCB), in Barcelona, Spain, throughout the 2020-2021 season. Participants were young players (from five different sports) and adult workers, who belonged to stable teams (shared routines and were involved in same quarantine rules). Biweekly health questionnaires and SARS-CoV-2 screening were conducted. From the 234 participants included, 70 (30%) both lived and trained in the FCB facilities (Recruitment Pathway 1;RP1) and 164 (70%) lived at their own household and just came to the facilities to train (RP2). During the study, 38 positive cases were identified; none had severe symptoms or needed hospitalization. The overall weekly incidence in the cohorts did not differ compared to the one expected in the community, except for 2 weeks when an outbreak occurred. The attack rate (AR) was three times higher for the participants from RP1, in comparison to those from RP2 (p < 0.01). A Basketball team showed a significant higher AR.  Conclusion: Physical activities in stable teams are not related to an increased risk of transmission of SARS-CoV-2, since there were the same observed cases than expected in the community. The risk is higher in indoor sports (Basketball vs. Football), and in closed cohort living settings (RP1 vs. RP2). The fulfilment of preventive measures is essential. What is Known: • Despite the low numerical impact caused in paediatric hospitalizations during COVID-19 pandemic, the social impact has been maximum. • The transmission potential in children and teenagers is limited, and it had been widely demonstrated in school settings. What is New: • Group physical activities in children and teenagers are not also related to an increased risk of transmission of SARS-CoV-2, when preventive measures, such as washing hands, and screening protocols are applied. • Routine and semi-professional sports activities seem safe environments to promote during this pandemic.

Low transmission of SARS-CoV-2 derived from children in family clusters: An observational study of family households in the Barcelona Metropolitan Area, Spain.

BACKGROUND: Family clusters offer a good opportunity to study viral transmission in a stable setting. We aimed to analyze the specific role of children in transmission of SARS-CoV-2 within households. METHODS: A prospective, longitudinal, observational study, including children with documented acute SARS-CoV-2 infection attending 22 summer-schools in Barcelona, Spain, was performed. Moreover, other patients and families coming from other school-like environments that voluntarily accessed the study were also studied. A longitudinal follow-up (5 weeks) of the family clusters was conducted to determine whether the children considered to be primary cases were able to transmit the virus to other family members. The household reproduction number (Re*) and the secondary attack rate (SAR) were calculated. RESULTS: 1905 children from the summer schools were screened for SARS-CoV-2 infection and 22 (1.15%) tested positive. Moreover, 32 additional children accessed the study voluntarily. Of these, 37 children and their 26 households were studied completely. In half of the cases (13/26), the primary case was considered to be a child and secondary transmission to other members of the household was observed in 3/13, with a SAR of 14.2% and a Re* of 0.46. Conversely, the SAR of adult primary cases was 72.2% including the kids that gave rise to the contact tracing study, and 61.5% without them, and the estimated Re* was 2.6. In 4/13 of the paediatric primary cases (30.0%), nasopharyngeal PCR was persistently positive > 1 week after diagnosis, and 3/4 of these children infected another family member (p<0.01). CONCLUSIONS: Children may not be the main drivers of the infection in household transmission clusters in the study population. A prolonged positive PCR could be associated with higher transmissibility.

Safety and effectiveness of bubble continuous positive airway pressure as respiratory support for bronchiolitis in a pediatric ward.

The results of several clinical trials suggest that continuous positive airway pressure (CPAP) for acute bronchiolitis can be more effective than high-flow nasal cannula (HFNC). The use of HFNC involved a minimum reduction (5%) in admissions to the pediatric intensive care unit (PICU) in our hospital. Our main aim was to evaluate its safety and effectiveness as respiratory support for patients with bronchiolitis in a pediatric general ward. A secondary goal was to compare the admissions to PICU and the invasive mechanical ventilation (IMV) rate of patients treated with HFNC and those treated with HFNC/b-CPAP during the 2018-2019 and 2019-2020 epidemic seasons, respectively. Two prospective single-centre observational studies were performed. For the main aim, a cohort study (CS1) was carried out from 1st of November 2019 to 15th of January 2020. Inclusion criteria were children aged up to 3 months with bronchiolitis treated with b-CPAP support when HFNC failed. Epidemiological and clinical parameters were collected before and 60 min after the onset of CPAP and compared between the responder (R) and non-responders (NR) groups. NR was the group that required PICU admission. One hundred fifty-eight patients were admitted to the ward with bronchiolitis and HFNC. Fifty-seven out of one hundred fifty-eight required b-CPAP. No adverse events were observed. Thirty-two out of fifty-seven remained in the general ward (R-group), and 25/57 were admitted to PICU (NR-group). There were statistically significant differences in respiratory rate (RR) and heart rate (HR) between both groups before and after the initiation of b-CPAP, but the multivariable models showed that the main differences were observed after 60 min of therapy (lower HR, RR, BROSJOD score and FiO2 in the R-group). For the secondary aim, another cohort study (CS2) was performed comparing data from a pre-b-CPAP bronchiolitis season (1st of November 2018 to 15th January 2019) and the b-CPAP season (2019-2020). Inclusion criteria in pre-b-CPAP season were children aged up to 3 months admitted to the same general ward with moderate-severe bronchiolitis and with HFNC support. Admissions to PICU during the CPAP season were significantly reduced, without entailing an increase in the rate of IMV. CONCLUSION: The implementation of b-CPAP for patients with bronchiolitis in a pediatric ward, in whom HFNC fails, is safe and effective and results in a reduction in PICU admissions. WHAT IS KNOWN: • Bronchiolitis is one of the most frequent respiratory infections in children and one of the leading causes of hospitalization in infants. • Several studies suggest that the use of continuous positive airway pressure (CPAP) for acute bronchiolitis can be more effective than the high flow nasal cannula (HFNC). CPAP is a non-invasive ventilation (NIV) therapy used in patients admitted to pediatric intensive care unit (PICU) with progressive moderate-severe bronchiolitis. There is little experience in the literature on the use of continuous positive airway pressure (CPAP) for acute bronchiolitis in a general ward. WHAT IS NEW: • CPAP could be safely and effectively used as respiratory support in young infants with moderate-severe bronchiolitis in a general ward and it reduced the rate of patients who required PICU admission. • Patients' heart and respiratory rate and their FiO2 needs in the first 60 minutes may help to decide whether or not to continue the CPAP therapy in a general ward.

Multiplex Antibody Analysis of IgM, IgA and IgG to SARS-CoV-2 in Saliva and Serum From Infected Children and Their Close Contacts.

COVID-19 affects children to a lesser extent than adults but they can still get infected and transmit SARS-CoV-2 to their contacts. Field deployable non-invasive sensitive diagnostic techniques are needed to evaluate the infectivity dynamics of SARS-CoV-2 in pediatric populations and guide public health interventions, particularly if this population is not fully vaccinated. We evaluated the utility of high-throughput Luminex assays to quantify saliva IgM, IgA and IgG antibodies against five SARS-CoV-2 spike (S) and nucleocapsid (N) antigens in a contacts and infectivity longitudinal study in 122 individuals (52 children and 70 adults). We compared saliva versus serum/plasma samples in infected children and adults diagnosed by weekly RT-PCR over 35 days (n=62), and those who consistently tested negative over the same follow up period (n=60), in the Summer of 2020 in Barcelona, Spain. Saliva antibody levels in SARS-CoV-2 RT-PCR positive individuals were significantly higher than in negative individuals and correlated with those measured in sera/plasmas. Asymptomatic infected individuals had higher levels of anti-S IgG than symptomatic individuals, suggesting a protective anti-disease role for antibodies. Higher anti-S IgG and IgM levels in serum/plasma and saliva, respectively, in infected children compared to infected adults could also be related to stronger clinical immunity in them. Among infected children, males had higher levels of saliva IgG to N and RBD than females. Despite overall correlation, individual clustering analysis suggested that responses that may not be detected in blood could be patent in saliva, and vice versa. In conclusion, measurement of SARS-CoV-2-specific saliva antibodies should be considered as a complementary non-invasive assay to serum/plasma to determine COVID-19 prevalence and transmission in pediatric populations before and after vaccination campaigns.

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Children in Summer Schools Applying Stringent Control Measures in Barcelona, Spain.

BACKGROUND: Understanding the role of children in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is critical to guide decision-making for schools in the pandemic. We aimed to describe the transmission of SARS-CoV-2 among children and adult staff in summer schools. METHODS: During July 2020, we prospectively recruited children and adult staff attending summer schools in Barcelona who had SARS-CoV-2 infection. Primary SARS-CoV-2 infections were identified through (1) a surveillance program in 22 summer schools of 1905 participants, involving weekly saliva sampling for SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) during 2-5 weeks; and (2) cases identified through the Catalonian Health Surveillance System of children diagnosed with SARS-CoV-2 infection by nasopharyngeal RT-PCR. All centers followed prevention protocols: bubble groups, handwashing, face masks, and conducting activities mostly outdoors. Contacts of a primary case within the same bubble were evaluated by nasopharyngeal RT-PCR. Secondary attack rates and the effective reproduction number in summer schools (Re*) were calculated. RESULTS: Among the >2000 repeatedly screened participants, 30 children and 9 adults were identified as primary cases. A total of 253 close contacts of these primary cases were studied (median, 9 [interquartile range, 5-10] for each primary case), among which 12 new cases (4.7%) were positive for SARS-CoV-2. The Re* was 0.3, whereas the contemporary rate in the general population from the same areas in Barcelona was 1.9. CONCLUSIONS: The transmission rate of SARS-CoV-2 infection among children attending school-like facilities under strict prevention measures was lower than that reported for the general population. This suggests that under preventive measures schools are unlikely amplifiers of SARS-CoV-2 transmission, supporting current recommendations for school opening.

Antibody conversion rates to SARS-CoV-2 in saliva from children attending summer schools in Barcelona, Spain.

BACKGROUND: Surveillance tools to estimate viral transmission dynamics in young populations are essential to guide recommendations for school opening and management during viral epidemics. Ideally, sensitive techniques are required to detect low viral load exposures among asymptomatic children. We aimed to estimate SARS-CoV-2 infection rates in children and adult populations in a school-like environment during the initial COVID-19 pandemic waves using an antibody-based field-deployable and non-invasive approach. METHODS: Saliva antibody conversion defined as ≥ 4-fold increase in IgM, IgA, and/or IgG levels to five SARS-CoV-2 antigens including spike and nucleocapsid constructs was evaluated in 1509 children and 396 adults by high-throughput Luminex assays in samples collected weekly in 22 summer schools and 2 pre-schools in 27 venues in Barcelona, Spain, from June 29th to July 31st, 2020. RESULTS: Saliva antibody conversion between two visits over a 5-week period was 3.22% (49/1518) or 2.36% if accounting for potentially cross-reactive antibodies, six times higher than the cumulative infection rate (0.53%) assessed by weekly saliva RT-PCR screening. IgG conversion was higher in adults (2.94%, 11/374) than children (1.31%, 15/1144) (p=0.035), IgG and IgA levels moderately increased with age, and antibodies were higher in females. Most antibody converters increased both IgG and IgA antibodies but some augmented either IgG or IgA, with a faster decay over time for IgA than IgG. Nucleocapsid rather than spike was the main antigen target. Anti-spike antibodies were significantly higher in individuals not reporting symptoms than symptomatic individuals, suggesting a protective role against COVID-19. CONCLUSION: Saliva antibody profiling including three isotypes and multiplexing antigens is a useful and user-friendlier tool for screening pediatric populations to detect low viral load exposures among children, particularly while they are not vaccinated and vulnerable to highly contagious variants, and to recommend public health policies during pandemics.

[Profile of the child seen in the resuscitation room]. / Perfil del niño atendido en la sala de críticos de Urgencias.

OBJECTIVE: The attention provided to the seriously ill represents a great challenge for health care professionals; familiarity with this profile will allow for the optimal use of resources and will also lead to an improvement in the training of the health professionals. We sought to understand the characteristics of patients seen in the resuscitation room (RR) of a pediatric emergency department (PED), and to determine the risk factors for a poor evolution. METHODS: An observational analytical study was carried out in the PED of a third-level pediatric hospital from September 2016 through August 2017. Included were those patients attended to in the RR; we analyzed their demographic variables, where they were from, how they arrived at the hospital, their reasons for seeking care (medical vs accident), procedures applied, treatments given, diagnoses, and discharge destination. We used logistic regression analysis to determine the independent risk factors for poor evolution. RESULTS: Included were 114 patients. Their median age was 9.9 years (p25-75=4.0-14.7); 65.8% were male. The patients arrived from the street (51.8%) and from home (31.6%); more than two thirds arrived by ambulance (69.3%). Some 42.1% presented with an unstable pediatric assessment triangle (PAT). Some 64.9% were seen for polytrauma (87.8% with stable PAT). Procedures were carried out on 79.8% of the patients. The most frequent diagnoses were polytrauma (64.9%) and convulsive status (14%). The discharge destinations were: home (28.1%), hospital ward (35.1%), intensive care unit (30.7%), and surgery (4.4%); two patients died in the RR. With the univariate study, we identified risk factors for poor outcome: internal medical condition (52.5% vs 21.6%, p=0.001) and age <2 years (55.6% vs 28.1%, p=0.023). In the multivariate study, the medical cause was maintained as an independent risk factor (OR 4 (CI 95% 1.7-9.2), p=0.001). CONCLUSIONS: The profile of the patient seen in the RR is of a school-age child in stable condition, arriving by ambulance for polytrauma. The children seen for internal medical reasons had poorer outcomes.

OBJETIVO: La atención sanitaria a los pacientes gravemente enfermos constituye un reto sanitario; es importante conocer el perfil de estos pacientes, para optimizar los recursos y mejorar la formación de los profesionales. El objetivo del estudio fue conocer las características de los pacientes atendidos en la Sala de Críticos (SC) de un Servicio de Urgencias Pediátricas (SUP) y determinar los factores de riesgo de mala evolución. METODOS: Se realizó un estudio analítico observacional en el SUP de un hospital pediátrico terciario, entre septiembre de 2016 y agosto de 2017. Se incluyeron los pacientes atendidos en la SC, analizando variables demográficas, procedencia, medio de traslado, motivo de consulta (médica o traumática), procedimientos, tratamientos, diagnóstico y destino. Mediante regresión logística se determinaron los factores de riesgo independientes de mala evolución. RESULTADOS: Se incluyeron 114 pacientes. La mediana de edad fue de 9,9 años (p25-75=4,0-14,7), de los que un 65,8% eran varones. Los pacientes llegaban de la vía pública (51,8%) y del domicilio (31,6%), con un 69,3% mediante traslado en ambulancia. El 42,1% presentaba triángulo de evaluación pediátrica (TEP) inestable. El 64,9% fueron atendidos por politraumatismos (87,8% TEP estable). Al 79,8% se les realizó algún procedimiento. Los diagnósticos más frecuentes fueron politraumatismo (64,9%) y "status" convulsivo (14%). El destino de los pacientes fue domicilio (28,1%), planta (35,1%), Unidad de Cuidados Intensivos (30,7%) o quirófano (4,4%). Dos pacientes resultaron éxitus en la SC. En el estudio univariante, se identificaron como factores de riesgo de mala evolución la causa médica (52,5% frente a un 21,6%, p=0,001) y la edad menor a 2 años (55,6% frente a un 28,1%, p=0,023). En el estudio multivariante, la causa médica se mantuvo como factor de riesgo independiente (OR 4 (IC 95% 1,7-9,2), p=0,001). CONCLUSIONES: El perfil del paciente atendido en la SC es un niño estable en edad escolar, que llega en ambulancia y generalmente por politraumatismo. Los niños atendidos por causa médicas tienen mayor riesgo de peor evolución.

Molecular and Clinical Comparison of Enterovirus D68 Outbreaks among Hospitalized Children, Ohio, USA, 2014 and 2018.

Enterovirus D68 (EV-D68) causes respiratory tract infections and neurologic manifestations. We compared the clinical manifestations from 2 EV-D68 outbreaks in 2014 and 2018 and a low-activity period in 2016 among hospitalized children in central Ohio, USA, and used PCR and sequencing to enable phylogenetic comparisons. During both outbreak periods, infected children had respiratory manifestations that led to an increase in hospital admissions for asthma. The 2018 EV-D68 outbreak appeared to be milder in terms of respiratory illness, as shown by lower rates of pediatric intensive care unit admission. However, the frequency of severe neurologic manifestations was higher in 2018 than in 2014. During the same period in 2016, we noted neither an increase in EV-D68 nor a significant increase in asthma-related admissions. Phylogenetic analyses showed that EV-D68 isolates from 2018 clustered differently within clade B than did isolates from 2014 and are perhaps associated with a different EV-D68 subclade.

Perfil del niño atendido en la sala de críticos de Urgencias / Profile of the child seen in the resuscitation room

OBJETIVO: La atención sanitaria a los pacientes gravemente enfermos constituye un reto sanitario; es importante conocer el perfil de estos pacientes, para optimizar los recursos y mejorar la formación de los profesionales. El objetivo del estudio fue conocer las características de los pacientes atendidos en la Sala de Críticos (SC) de un Servicio de Urgencias Pediátricas (SUP) y determinar los factores de riesgo de mala evolución. MÉTODOS: Se realizó un estudio analítico observacional en el SUP de un hospital pediátrico terciario, entre septiembre de 2016 y agosto de 2017. Se incluyeron los pacientes atendidos en la SC, analizando variables demográficas, procedencia, medio de traslado, motivo de consulta (médica o traumática), procedimientos, tratamientos, diagnóstico y destino. Mediante regresión logística se determinaron los factores de riesgo independientes de mala evolución. RESULTADOS: Se incluyeron 114 pacientes. La mediana de edad fue de 9,9 años (p25-75=4,0-14,7), de los que un 65,8% eran varones. Los pacientes llegaban de la vía pública (51,8%) y del domicilio (31,6%), con un 69,3% mediante traslado en ambulancia. El 42,1% presentaba triángulo de evaluación pediátrica (TEP) inestable. El 64,9% fueron atendidos por politraumatismos (87,8% TEP estable). Al 79,8% se les realizó algún procedimiento. Los diagnósticos más frecuentes fueron politraumatismo (64,9%) y "status" convulsivo (14%). El destino de los pacientes fue domicilio (28,1%), planta (35,1%), Unidad de Cuidados Intensivos (30,7%) o quirófano (4,4%). Dos pacientes resultaron éxitus en la SC. En el estudio univariante, se identificaron como factores de riesgo de mala evolución la causa médica (52,5% frente a un 21,6%, p = 0,001) y la edad menor a 2 años (55,6% frente a un 28,1%, p = 0,023). En el estudio multivariante, la causa médica se mantuvo como factor de riesgo independiente (OR 4 (IC 95% 1,7-9,2), p = 0,001). CONCLUSIONES: El perfil del paciente atendido en la SC es un niño estable en edad escolar, que llega en ambulancia y generalmente por politraumatismo. Los niños atendidos por causa médicas tienen mayor riesgo de peor evolución

OBJECTIVE: The attention provided to the seriously ill represents a great challenge for health care professionals; familiarity with this profile will allow for the optimal use of resources and will also lead to an improvement in the training of the health professionals. We sought to understand the characteristics of patients seen in the resuscitation room (RR) of a pediatric emergency department (PED), and to determine the risk factors for a poor evolution. METHODS: An observational analytical study was carried out in the PED of a third-level pediatric hospital from September 2016 through August 2017. Included were those patients attended to in the RR; we analyzed their demographic variables, where they were from, how they arrived at the hospital, their reasons for seeking care (medical vs accident), procedures applied, treatments given, diagnoses, and discharge destination. We used logistic regression analysis to determine the independent risk factors for poor evolution. RESULTS: Included were 114 patients. Their median age was 9.9 years (p25-75=4.0-14.7); 65.8% were male. The patients arrived from the street (51.8%) and from home (31.6%); more than two thirds arrived by ambulance (69.3%). Some 42.1% presented with an unstable pediatric assessment triangle (PAT). Some 64.9% were seen for polytrauma (87.8% with stable PAT). Procedures were carried out on 79.8% of the patients. The most frequent diagnoses were polytrauma (64.9%) and convulsive status (14%). The discharge destinations were: home (28.1%), hospital ward (35.1%), intensive care unit (30.7%), and surgery (4.4%); two patients died in the RR. With the univariate study, we identified risk factors for poor outcome: internal medical condition (52.5% vs 21.6%, p = 0.001) and age <2 years (55.6% vs 28.1%, p = 0.023). In the multivariate study, the medical cause was maintained as an independent risk factor (OR 4 (CI 95% 1.7-9.2), p = 0.001). CONCLUSIONS: The profile of the patient seen in the RR is of a school-age child in stable condition, arriving by ambulance for polytrauma. The children seen for internal medical reasons had poorer outcomes