Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race.

OBJECTIVES: Pulse oximetry (Sp o2 ) may overestimate arterial oxygen saturation (Sa o2 ) in blood laboratory testing. This study aimed to assess Sp o2 -Sa o2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. DESIGN: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Sp o2 and Sa o2 data according to approved comparisons. Occult hypoxemia was defined as Sp o2 greater than 92% and Sa o2 less than 88%. SETTING: Quaternary pediatric hospital. PATIENTS: Pediatric COVID-19 patients admitted to Texas Children's Hospital between May 2020 and December 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients ( p < 0.001), and this bias increased as the oxygen saturations decreased ( p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively ( p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory). CONCLUSIONS: We found an oximetry bias in the measurement of Sp o2 with respect to Sa o2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.

Absence of human herpesvirus 6B detection in association with illness in children undergoing cancer chemotherapy.

The lymphotropic herpesviruses, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6B (HHV-6B) can reactivate and cause disease in organ transplant recipients; the contributions of HHV-6A and HHV-7 to disease are less certain. Less is known about their pathogenic roles in children undergoing treatment for malignancies. Children with newly diagnosed cancer were followed for 24 months. Clinical information and blood samples were collected during routine visits and during acute visits for fever or possible viral infections. Lymphotropic herpesvirus DNA in blood was measured by polymerase chain reaction (PCR). Although HHV-6B DNA was detected at least once in about half of the patients; the other viruses were seldom detected. There was no association between HHV-6B detection and individual acute clinical events, however, HHV-6B detection was more common in children who experienced more frequent acute clinical events. In children being treated for various malignancies, HHV-6B detection was common, but was not associated with individual events of acute illness. Thus, if HHV-6B is not assessed longitudinally, clinical events may be misattributed to the virus. The elevated frequency of detection of HHV-6B in sicker children is consistent with prior reports of its detection during apparently unrelated acute clinical events. J. Med. Virol. 88:1427-1437, 2016. © 2016 Wiley Periodicals, Inc.

High-Risk Anomalous Aortic Origin of the Left Coronary Artery: Consecutive Admissions Presenting With Sudden Cardiac Arrest.

Anomalous aortic origin of the left coronary artery (AAOLCA) confers high risk for sudden cardiac arrest (SCA). This series aims to describe consecutive admissions with interarterial AAOLCA presenting with SCA and distinct clinical trajectories. An eight-year-old boy collapsed at school and received 10-min of cardiopulmonary resuscitation (CPR) and defibrillation prior to return of spontaneous circulation. He had no end-organ dysfunction and underwent uneventful coronary unroofing. In contrast, a 14-year-old boy presented with collapse while jogging. He received 40-min of CPR prior to extracorporeal membranous oxygenation cannulation with multisystem dysfunction and persistent severely depressed left ventricular function. He is now rehabilitating following uneventful orthotropic heart transplantation. These cases illustrate the diverse outcomes of AAOLCA with SCA following exertional syncope.