COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey.

To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions.  Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital.

The clinical follow-up and management of COVID-19 in children and adolescents with an immunocompromised state or a malignancy.

BACKGROUND: It is still not known how an immunosuppressive state affects the response to coronavirus disease 2019 (COVID-19) in children and adolescents. The aim of this study was to evaluate clinical characteristics, outcomes, and follow-up results of COVID-19 in pediatric patients with a history of immunocompromise or malignancy, retrospectively. METHODS: Patients with a diagnosis of COVID-19 who were under 18 years of age and had a history of immunosuppressive chronic disease or under immunosuppressant treatment were included in the study. Patients were applied to our outpatient clinic or consulted to our department in a tertiary center during the first year of the pandemic. RESULTS: We evaluated 18 patients with a median age of 15.0 (0.6-17.8) years. Twelve patients (66.6%) were tested because of a symptom and the most common symptom was fever (44.4%, n = 8). Ten of the symptomatic patients (55.5% of all cohort) had a mild disease, the remaining two patients (11.1%) with an end-stage malignancy had critical diseases. Twelve patients (66.7%) were managed on an outpatient basis and were followed up at home, while the remaining six (33.3%) required hospitalization. One patient, who had Ewing sarcoma, died during the follow-up in the intensive care unit, and others were recovered without any morbidities. Lymphocyte (LYM) counts were significantly lower, C-reactive protein (CRP), and ferritin levels were higher in the individuals that needed hospitalization (p = 0.039, 0.027, and 0.039, respectively). DISCUSSION: Immunocompromised children and adolescents with COVID-19 should be monitored closely, especially those with an end-stage malignancy, low LYM count, or high CRP and ferritin levels.

Evaluation of Possible Effects of the COVID-19 Pandemic on Febrile Neutropenia Episodes in Children With Acute Leukemia.

With the rapid spread of coronavirus disease 2019 (COVID-19) around the globe, concerns about the management of patients with malignancy have risen significantly. This study aimed to investigate the possible impact of the COVID-19 pandemic and prevention policies on the incidence and etiology of febrile neutropenia (FN) episodes in children with acute leukemia. Children who had acute leukemia and were diagnosed as FN in a tertiary center from March 2018 to March 2021 were included in the study. FN episodes were grouped as prepandemic and postpandemic based on the date that pandemic was declared. Relevant data were collected retrospectively. We evaluated 113 FN episodes (75.2% were prepandemic) of 46 patients, a median of 4.7 (2.6 to 12.6) years of age. The number of FN episodes per patient did not differ between prepandemic and postpandemic periods ( P =0.476). There was no significant difference among the 2 groups regarding the microbiologic causes, focus of fever, and clinical outcomes in FN episodes. Two of the patients were diagnosed as COVID-19 and recovered without any complications. In conclusion, we showed that the incidence and etiology of FN episodes were similar before and during the COVID-19 pandemic in children with acute leukemia.

Evaluation of serum/salivary levels of carnosine and cotinine in recurrent wheezing of young children with passive smoking.

BACKGROUND: Recurrent wheezing is common in young children, with a cumulative prevalence of up to 40 % in the first 6 years of life. In this study, we aimed to evaluate the relationship between the number of wheezing episodes and the number of cigarettes smoked at home and serum / saliva cotinine and carnosine levels in children with recurrent wheezing. METHODS: This study was conducted with 80 young children with recurrent wheezing, aged between 1-4 years and 50 healthy control groups. Patient population was divided into three groups depending on the number of their exposure to cigarette smoke and wheezing attacks. Serum cotinine, saliva cotinine, serum carnosine, saliva carnosine, vitamin D levels were measured by using the ELISA method. RESULTS: A significant relationship for serum cotinine and saliva cotinine levels was found between groups (p < 0.05). It was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, the level of serum/saliva cotinine levels increased significantly, compared to the control group. In contrast, it was determined that as the number of exposure to cigarette smoke and number of wheezing episodes in young children with recurrent wheezing increased, serum/saliva carnosine levels decreased significantly, compared to the control group. In addition, a significant difference in serum vitamin D levels was found between healthy young children and young children with recurrent wheezing (p < 0.05). CONCLUSIONS: We think that the measurement of salivary cotinine is a useful and noninvasive marker to evaluate passive smoking exposure in the etiology of recurrent wheezing in young children.

Diagnostic Value of Neutrophil to Lymphocyte Ratio and Mean Platelet Volume on Early Onset Neonatal Sepsis on Term Neonate.

By setting out from increased neutrophil count, decreased lymphocyte count, and increased mean platelet volume (MPV), which is a result of the effect of inflammation on blood cells, we aimed to investigate whether neutrophil to lymphocyte ratio (NLP) and MPV can be used as an auxiliary parameter for the diagnosis of early-onset neonatal sepsis (EOS). This study was conducted by analyzing term neonates with EOS and physiological jaundice who were admitted to the neonatal intensive care unit of Izmir Katip Celebi University Ataturk Training and Research Hospital. A total of 63 neonate files were examined to include 30 term neonates with EOS, and 77 neonate files were examined to include 30 term neonates with physiological jaundice as a control group. NLR had an area under the curve (AUC) of 0.891 for prediction of EOS. At a cut-off level of 1.42, NLR had a likelihood ratio (LR) of 5.5, sensitivity of 88%, a specificity of 84%, a positive predictive value (PPV) of 84.6%, and a negative predictive value (NPV) of 87.5%. MPV had an AUC of 0.666 for the prediction of EOS and at a cut-off level of 9.3 fL, MPV had an LR of 1.23, sensitivity of 84%, a specificity of 32%, a PPV of 55.2%, and an NPV of 66.6%. In conclusion, this study provides evidence that NLR and MPV can be used in addition to conventional parameters in the diagnosis of EOS.