Autopsy findings of pediatric COVID-19: a systematic review.

Background: Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients. Results: There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review. Conclusion: Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities.

Comparison of Indonesian Growth Reference Chart and World Health Organization Child Growth Standard in Detecting Stunting: A Systematic Review and Meta-analysis of 15,874 Children

Recognition of an overestimation of stunted children in Indonesia when using the World Health Organization Child Growth Standards (WHOCGS) led to the creation of the Indonesian Growth Reference Chart (IGRC) in 2005, with further improvement in 2018. This systematic review aimed to determine whether there is a difference in the diagnosis of stunting when using these two charts. This systematic review is registered in the PROSPERO database (CRD42021259934). Literature research was performed on PubMed, Science Direct, Medline, Scielo, Medrxiv, Research Square, SSRN, and Biorxiv to identify studies published from 2018 onwards that examined the comparison of IGRC and WHOCGS in detecting stunting. Three studies were included in this review. Pooled analysis showed that IGRC resulted in a lower prevalence of stunted and severely stunted children [risk ratio (RR): 0.28 (95% confidence intervals (CI): 0.15-0.51), p<0.0001, I2=97%]. Comparison between IGRC and WHOGCS for prevalence of normal height children showed that there was no difference, and this finding was not significant [RR: 1.56 (95% CI: 0.92-2.66), p=0.1, I2=100%], and the comparison for prevalence of tall children also showed that there was no difference when using IGRC or WHOGCS, and this finding was also insignificant [RR: 2.02 (95% CI: 0.78-5.20), p=0.14, I2=98%]. This meta-analysis showed that stunted and severely stunted Indonesian children are over-represented using WHOCGS. The difference between IGRC and WHOCGS has occurred because of the sample population, as IGRC includes children from all 33 provinces in Indonesia, better reflecting the growth of all children in Indonesia.

Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants.

Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.