COVID-19 admissions: Trying to define the real impact of infection in hospitalized patients.

INTRODUCTION AND OBJECTIVE: Several studies have suggested that the hospitalization rate for COVID-19 in children and adolescents may reflect the prevalence of the infection rather than the severity of the disease. The aim of this study was to describe the clinical features of hospitalised paediatric patients with SARS-CoV-2 infection in order to understand if the infection was the reason for admission. METHODS: Retrospective cohort study including patients aged 0-18 years with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) admitted to a tertiary care children's hospital in Spain between 01/01/2020 and 12/31/2021. RESULTS: 228 patients were included, corresponding to 150 cases of COVID-related admission (SARS-CoV-2 infection as main cause of hospitalization) and 78 of non-COVID-related admission (SARS-CoV-2 infection unrelated to the hospitalization). In the group of COVID-related admissions, 58 patients had comorbidities. Forty-nine patients had acute respiratory disease (pneumonia, bronchospasm or bronchiolitis). Multisystem inflammatory syndrome in children was diagnosed in 27 and was significantly more frequent in the first year of the pandemic (wild type virus). Eighty percent of patients with acute respiratory disease needed respiratory support, mostly low-flow oxygen therapy. The severity of the disease was similar in all virus variants. Two patients (both with severe comorbidities) died from COVID-related conditions. CONCLUSIONS: In our study, one third of the patients were admitted with SARS-CoV-2 infection but not because of it. Acute respiratory disease was less frequent and had a better prognosis compared to the adult population, while MIS-C was a major cause of morbidity and hospitalization. The fatality rate was extremely low.

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.

Implicaciones clínicas de la retirada de alimentación e hidratación artificial en pacientes pediátricos en el final de vida / Clinical implications of artificial nutrition and hydration withdrawal in children at the end of life

Introducción: En la literatura de pacientes adultos, hay evidencia de que el mantenimiento de alimentación e hidratación artificial (ANH) en el final de vida se asocia a numerosos efectos adversos. La retirada de ANH podría asociarse a una disminución de estos, sin suponer disminución de supervivencia. En pediatría, hay gran falta de evidencia en estos aspectos. El objetivo de este estudio es describir el uso de ANH en pacientes pediátricos en final de vida, y las implicaciones clínicas derivadas de su mantenimiento o retirada. Metodología: Estudio observacional (prospectivo y retrospectivo) en un hospital pediátrico de tercer nivel. Se incluyeron pacientes de más de 24 h de vida que fallecieron en nuestro centro o en domicilio entre el 15 de julio de 2019 y el 15 de julio de 2020. La información fue recogida mediante entrevistas al equipo sanitario y la revisión de historias clínicas. Resultados: De los pacientes que recibían ANH, en la mitad de los casos esta se redujo o se retiró antes del fallecimiento. La retirada/reducción fue más frecuente en los pacientes que fallecieron en hospital versus domicilio. Se demostró una incidencia mayor de signos de deshidratación en los grupos que no recibieron ANH. Comparando los grupos que sí recibían ANH, se observó un leve aumento de signos en el grupo donde se retiró ANH con respecto al grupo en el que se mantuvo, sin ser significativo. La mediana de tiempo transcurrido entre retirada de ANH y fallecimiento fue de un día. Conclusiones: La reducción o retirada de ANH en pacientes pediátricos en el final de vida no parece suponer un aumento de signos de deshidratación. (AU)

Introduction: In the literature on adult patients, there is evidence that continuing artificial nutrition and hydration (ANH) during end of life is associated with numerous adverse effects. The withdrawal of ANH could lead to a reduction in these negative effects, without resulting in a reduced survival time. In pediatrics, evidence regarding this subject is sorely lacking. The objective of this study is to describe the use of ANH in pediatric patients at end of life, along with the clinical implications of continuing or withdrawing it. Methodology: Observational (prospective and retrospective) study in a tertiary pediatric hospital. Patients older than 24 hours who died at our center or at home between 07/15/2019 and 07/15/2020 were included. The information was collected via interviews with the healthcare team and by reviewing clinical records. Results: Of the patients who received ANH, in half of them this support was reduced or withdrawn prior to death. ANH was withdrawn/reduced in a higher percentage in patients who died in the hospital versus at home. A greater incidence of clinical signs of dehydration was seen in the groups that did not receive ANH. When compared with the groups that did receive ANH, a slight increase in these signs was observed for the group in which ANH was withdrawn versus that in which it was continued, without this difference being statistically significant. The median time elapsed between withdrawing ANH and death was one day. Conclusions: The reduction or withdrawal of ANH in pediatric patients does not appear to increase signs of dehydration. (AU)