COVID-19 in Children: Update on Diagnosis and Management

2021 ◽  
Vol 42 (06) ◽  
pp. 737-746
Author(s):  
Susanna Esposito ◽  
Luciana Abate ◽  
Serena Rosa Laudisio ◽  
Andrea Ciuni ◽  
Simone Cella ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Imaging Modality ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Therapeutic Management ◽  
Nasopharyngeal Swab ◽  
Symptomatic Therapy ◽  
Radiologic Findings ◽  
Individualized Approach ◽  
Few Data

AbstractIn December 2019, a new infectious disease called coronavirus disease 2019 (COVID-19) attributed to the new virus named severe scute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected. The gold standard for the diagnosis of SARS-CoV-2 infection is the viral identification in nasopharyngeal swab by real-time polymerase chain reaction. Few data on the role of imaging are available in the pediatric population. Similarly, considering that symptomatic therapy is adequate in most of the pediatric patients with COVID-19, few pediatric pharmacological studies are available. The main aim of this review is to describe and discuss the scientific literature on various imaging approaches and therapeutic management in children and adolescents affected by COVID-19. Clinical manifestations of COVID-19 are less severe in children than in adults and as a consequence the radiologic findings are less marked. If imaging is needed, chest radiography is the first imaging modality of choice in the presence of moderate-to-severe symptoms. Regarding therapy, acetaminophen or ibuprofen are appropriate for the vast majority of pediatric patients. Other drugs should be prescribed following an appropriate individualized approach. Due to the characteristics of COVID-19 in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics for an appropriate diagnosis and therapeutic management represents a priority.

scholarly journals The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Pi-Chang Lee ◽  
Betau Hwang ◽  
Wen-Jue Soong ◽  
C. C. Laura Meng
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Cor Pulmonale ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
Hemodynamic Characteristics ◽  
Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

scholarly journals Epidemiological and Clinical Characteristics of Children with Coronavirus Disease 2019

2020 ◽  
Author(s):  
Qin Wu ◽  
Yuhan Xing ◽  
Lei Shi ◽  
Wenjie Li ◽  
Yang Gao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Clinical Manifestations ◽  
Epidemiological Data ◽  
Good Prognosis ◽  
Pcr Analysis ◽  
Respiratory Pathogens ◽  
Upper Respiratory Tract ◽  
Radiologic Findings ◽  
Epidemiological Characteristics

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen which mainly spreads by droplets. Most published studies focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients is limited. This study aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19.MethodsWe reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome and follow-up results.ResultsFrom January 20th to February 27th of 2020, a total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 cases whose epidemiological data were complete, 65 (65/68, 95.59%) cases were household contacts of adults whose symptoms developed earlier. Forty (59.46%) of the infected children were male, and the median age and body weight are 6 (0.10-15.08) years and 24 (4.20-87.00) kg, respectively. Except for one critically ill case, 20 (27.03%) patients did not show any symptoms of infection, 24 (32.43%) patients had acute upper respiratory tract infection and 29 (39.19%) patients were diagnosed with mild pneumonia. Cough (24/74, 32.43%) and fever (20, 27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (19 / 34, 51.35%) showed co-infection with other pathogens other than SARS-CoV-2.Ten (13.51%) children had RT-PCR analysis of SARS-CoV-2 for fecal specimens and 8 of them showed prolonged existence of SARS-CoV-2 RNA 11 (5-23) days after nasopharynx swabs turning negative. Abnormalities in chest imaging were observed in 37 (50.00%) patients and 28 (37.84%) of them only presented with nontypical changes.All children had good prognosis with a median hospitalization duration of 11 days and follow-up period of 16.5 days. During the follow-up period, all the patients remained in quarantine at designated site and home for two 14-day obervation periods and showed no clinical manifestation,but 3 of the 8 cases with prolonged fecal shedding of SARS-CoV-2 still showed positive result of feces test.

Varicella in Pediatric Patients

1993 ◽  
Vol 27 (7-8) ◽  
pp. 938-949 ◽  
Author(s):  
Laureen A. Drwal-Klein ◽  
Carmel A. O'Donovan
Keyword(s):  
Varicella Zoster Virus ◽  
Antiviral Therapy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Varicella Vaccine ◽  
Clinical Manifestations ◽  
Search Term ◽  
Healthy Children ◽  
Varicella Zoster ◽  
Treatment And Prevention

OBJECTIVE: To summarize the literature describing the epidemiology, transmission, clinical manifestations, diagnosis, treatment, and prevention of varicella in the pediatric population. DATA SOURCES: A literature search of English-language articles from 1982 to 1992 using MEDLINE and bibliographies of relevant articles. The search term used was varicella. STUDY SELECTION: All review articles and original studies addressing the epidemiology, transmission, clinical manifestations, complications, diagnosis, treatment, and prevention of varicella in pediatric patients were reviewed. Emphasis was placed on controlled studies done in the US. DATA EXTRACTION: Data from human studies were extracted by the authors and evaluated according to patient population, sample size, dosing regimen, efficacy, and safety. DATA SYNTHESIS: Varicella-zoster virus is a highly contagious virus that produces a common and costly disease in the pediatric population. The primary manifestation of varicella is the eruption of vesicular lesions. In most cases varicella is benign, but it can be associated with serious complications. Diagnosis is based primarily on clinical findings. Otherwise healthy children have traditionally received only symptomatic treatment for varicella, but recent literature suggests that antiviral therapy may be useful in these patients. Immunocompromised patients benefit from both symptomatic and antiviral therapy. Isolation and varicella-zoster immune globulin are used to prevent varicella. In the future, varicella vaccine will play an important role in preventing the disease. Varicella vaccine has been shown to be immunogenic and clinically effective in both healthy and immunocompromised children. Adverse reactions associated with the vaccine include fever, injection-site reactions, and rash. Although zoster can follow vaccination, the incidence appears to be lower in vaccinated individuals. Preliminary studies have shown that the vaccine provides protection from varicella-zoster virus for an extended period of time. CONCLUSIONS: Varicella is a common, usually benign disease of childhood. All patients may benefit from symptomatic therapy. Current literature does not support the use of antiviral therapy in all pediatric patients with varicella. When commercially available, varicella vaccine will play an important role in prevention. Long-term studies are needed to fully assess the risk of developing varicella and zoster following vaccination.

Staging in childhood lymphoma

2005 ◽  
Vol 44 (01) ◽  
pp. 1-7 ◽  
Author(s):  
D. Wormanns ◽  
M. Pixberg ◽  
A. Hunold ◽  
W. Heindel ◽  
H. Jürgens ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Pediatric Patients ◽  
Imaging Modality ◽  
Whole Body ◽  
Clinical Value ◽  
Negative Results ◽  
Positron Emission ◽  
Few Data ◽  
Childhood Lymphoma ◽  
The Impact

Summary Aim: The clinical value of positron emission tomography using fluorine-18 fluoro-deoxy-glucose (FDG-PET) in the staging of adult lymphoma has been shown in many studies. However, there are only few data regarding childhood lymphoma. The purpose of this retrospective study was to compare the staging of childhood lymphoma using FDG-PET and the established computed tomography (CT). Method: Whole-body FDG-PET was performed in 25 children with histologically proven Hodgkin ´s disease (n = 18) and non-Hodgkin´s lymphoma (n = 7) using a dedicated PET. The findings were compared with the CT results. Both examinations, FDG-PET and CT, were assessed by two experienced physicians. In each patient, 30 regions were analysed (22 nodal, 8 extranodal). Each region was assessed using a fivevalue scale (definitely/probably positive, equivocal, probably/definitely negative). Results: 662 regions (470 nodal, 192 extranodal) were compared. 91 regions (81 nodal, 10 extranodal; 14%) were concordant positive and 517 regions (347 nodal, 170 extranodal; 78%) were concordant negative. In 47 regions, 48 discordant findings (7%) were described: 27 findings (22 nodal, 5 extranodal) were positive using FDG-PET and negative using CT whereas 21 findings (17 nodal, 4 extranodal) were positive using CT and negative using PET. A total of 7 regions (1%) were judged equivocal in one imaging modality (1 FDG-PET, 6 CT). Using FDG-PET as compared to CT, resulted in a higher staging in 4 of 25 patients and in a lower staging in 2 of 25 patients. Conclusion: Staging of childhood lymphoma using FDGPET shows differences compared with CT resulting in a different staging in 6 of 25 patients. Prospective studies are required to evaluate the impact of these discrepancies on the clinical management of pediatric patients.

scholarly journals Clinical manifestations of chikungunya infection in the pediatric population: systematic review

2019 ◽  
pp. e997
Author(s):  
Rodrigo Rufino Pereira Silva ◽  
Sabrina Rufino Pereira Silva ◽  
Luiz Custódio Moreira Júnior ◽  
Vanessa Lima Gonçalves ◽  
Larissa Costa Araújo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Search Strategy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Age Group ◽  
The Subject ◽  
Review Study ◽  
Neonatal Population ◽  
Made In

Objective: To describe the clinical manifestations, especially those related to rheumatology, in the infant and neonatal population with Chikungunya viral, which are described in case studies in the literature. Methods: This is about a systematic review study, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) methodology. In order to identify the articles about the subject, the databases indexed to the BVS and SCIELO were searched, from June to July 2019, with the following search strategy: chikungunya virus and arthritis, arthralgia rheumatoid and chikungynya fever and arboviruses and arthralgia. Filters used included articles in English that have been published in the last 5 years. Manual searches were made in the bibliographic references of the articles found. Results: Six articles were reviewed, which addressed cases of Chikungunya confirmed pediatric patients. It was noticed that the main clinical manifestations were: fever, cutaneous symptoms, irritability and vomiting. Regarding rheumatologic symptoms, it was concluded that arthralgia and arthritis are uncommon in these patients, and residual arthritis is much less frequent in this age group. Conclusion: The control of the symptomatology and the dissemination of information related to the transmission of the virus helps in the promotion of health, and the complications of the disease must be known in time to be minimized.

scholarly journals Serum Vitamin D levels in pediatric patients and its association with COVID-19 clinical manifestation: A meta-analysis and systematic review

2021 ◽  
Vol 17 (2) ◽  
pp. 076-085
Author(s):  
Andrew Jonatan ◽  
Retno Asih Setyoningrum
Keyword(s):  
Vitamin D ◽  
Clinical Manifestation ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Human Immune System ◽  
Serum Vitamin D ◽  
Vitamin D Levels

Background: Vitamin D is involved in human immune system homeostasis and thought to be beneficial for COVID-19 patients, including pediatric population. However, there is still a paucity of information on association of serum vitamin D levels and COVID-19 clinical manifestation in pediatric patients. This study evaluated the association between serum vitamin D levels and clinical manifestations of COVID-19 in pediatric patients. Methods: We searched PubMed and Google Scholar for articles reporting association between vitamin D and COVID-19 clinical manifestations in pediatric patients. We searched for English-written articles only. PRISMA-MOOSE guideline and quality checklist was complied and statistical analysis was performed using RevMan 5.4. Results: Ten studies with total of 1,225 patients reported were reviewed. Low vitamin D levels was significantly associated with higher incidence of severe COVID-19 with pooled OR was 5.57 (1.59-19.55; p=0.007). Clinical symptoms were compared between low and normal vitamin D levels. Incidence of fever, cough, ageusia, anosmia, headache, and fatigue were not significantly different between group, with pooled RR was 2.13 (0.13-33.73; p=0.59), 1.25 (0.25-6.22; p=0.78), 0.47 (0.05-4.76; p=0.52), 1.25 (0.21-7.41; p=0.81), 0.91 (0.33-2.55; p=0.86), and 1.02 (0.47-2.22; p=0.96), respectively. The mean count of leukocytes and lymphocytes in the two groups were also not significantly different with pooled RR was -0.49 (-1.39-0.41; p=0.28), and -0.73 (-1.65-0.20; p=0.12), respectively. Conclusion: Low serum vitamin D level (<20 ng/ml) is associated with the severity of COVID-19 in pediatric patients, but do not affect symptoms and laboratory parameters. Vitamin D supplementation might be beneficial for children undergo medical quarantine and isolation.

scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

The Use of Sonography in Pediatrics: The Bioethical Concerns in Clinical and Research Practice

2021 ◽  
pp. 875647932110350
Author(s):  
Nicole Weikle
Keyword(s):  
Clinical Setting ◽  
Imaging Modality ◽  
Pediatric Population ◽  
Well Being ◽  
Ethical Principles ◽  
Pediatric Care ◽  
Research Practice ◽  
Ethical Guidelines ◽  
Non Invasive ◽  
Clinical Pediatric

Sonography has been widely used in both a clinical and non-clinical setting. This imaging modality is a common tool of choice for both physicians and researchers. Although sonography is a non-ionizing and non-invasive tool for imaging, special considerations need to be made when working with the pediatric population. Ethical guidelines for clinical pediatric care and research need to consider the varying ethical guidelines and bioethical concerns in children. As sonographers, researchers, educators and clinicians, pediatric care and research must balance the protection of children and the need for imaging to improve pediatric well-being. The discussion of this paper will delve into The Principles Approach developed by Beauchamp and Childress. Each principle will be explored and how those ethical principles could be considered in pediatric care.

scholarly journals 1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S836-S837
Author(s):  
Juliana Mejia- Mertel ◽  
Juan P Rojas -Hernandez
Keyword(s):  
Virus Type ◽  
Low Income ◽  
Pacific Coast ◽  
Vision Loss ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Low Income Countries ◽  
Nutritional Deficiencies ◽  
Type I ◽  
T Lymphotropic Virus

Abstract Background The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients. Methods Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020. Results Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies. None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies. Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis. Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation. Summary features HTLV-1 patients Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular. Conclusion It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries. Disclosures All Authors: No reported disclosures

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

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