Hospitalized Children with Critical SARS-CoV-2 Infection Cared for in a Limited Resource Setting: Multicenter Cohort Study

Abstract Background: Some children can develop severe forms of SARS-CoV-2 infection either acutely or later, as represented by multisystemic inflammatory syndrome in children (MIS- C). To identify the risk factors for worse outcomes in hospitalized children and adolescents with severe acute SARS-CoV-2 infection and MIS-C. Methods: This multicenter cohort study included all children and adolescents with confirmed or suspected critical SARS-CoV-2 infection admitted to the PICU between April 2020 and September 2021. The exclusion criteria were incomplete vaccinal status, immunocompromised status, and end-of-life decision. The main variables analyzed were epidemiological, clinical, and laboratory data, and ventilator settings at admission and after 72 h. The patients were divided into three groups (G): confirmed coronavirus disease (COVID-19) with MIS-C criteria (G1), confirmed COVID-19 without MIS-C criteria (G2), and MIS-C criteria without confirmed COVID-19. Results: The median age of the patients was 28 months in G1, with comorbidities in 40 patients (72.7%) (p < 0.0001). The duration of exposure (median 23 days; p = 0.004) and fever were longer in G1 (12 days; p = 0.001). Moreover, invasive mechanical ventilation (IMV) was required in 44 patients (80%, p < 0.0001), and cardiogenic shock occurred in 26 patients (54.2%, p < 0.0001) in G1. Subnutrition was most frequent in G1 in 55 cases (57.3%; p = 0.01). Under nutrition (< 2 SD for weight), longer exposure time (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.37–3.25; p = 0.001), IMV time (OR: 2.6; 95% CI: 1.15–5.85; p = 0.03), and length of hospital stay (OR: 10.94; 95% CI: 1.93–63.1; p = 0.007) were associated with critical MIS-C in G1. Conclusions: In the Brazilian Amazon area, specifically in the Pará state, we identified a cluster of more severe forms of pediatric acute or late SARS-CoV-2 infection.

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Diagnostic Performance Analysis of a Three-Dimensional Depth Sensor Imaging in Identifying Idiopathic Scoliosis in Children and Adolescents: A Prospective Multicenter Cohort Study

SSRN Electronic Journal ◽

10.2139/ssrn.3350554 ◽

2019 ◽

Author(s):

Terufumi Kokabu ◽

Noriaki Kawakami ◽

Koki Uno ◽

Toshiaki Kotani ◽

Teppei Suzuki ◽

...

Keyword(s):

Cohort Study ◽

Performance Analysis ◽

Idiopathic Scoliosis ◽

Children And Adolescents ◽

Diagnostic Performance ◽

Three Dimensional ◽

Depth Sensor ◽

Multicenter Cohort Study ◽

Multicenter Cohort

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The Impact of Postnatal Systemic Steroids on the Growth of Preterm Infants: A Multicenter Cohort Study

Nutrients ◽

10.3390/nu11112729 ◽

2019 ◽

Vol 11 (11) ◽

pp. 2729

Author(s):

Carlos Zozaya ◽

Alejandro Avila-Alvarez ◽

Fermín García-Muñoz Rodrigo ◽

María L. Couce ◽

Luis Arruza ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Postnatal Growth ◽

Linear Regression Models ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Major Congenital Malformations ◽

The Impact

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate–severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate–severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: −0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: −0.03 to 0.01 cm/week) or head circumference growth (−0.01; 95% CI: −0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.

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Clinical Findings, Laboratory Assessment, and Outcomes of 44 Infants Born to Mothers with Confirmed or Suspected COVID-19: A Multicenter Cohort Study

Iranian Journal of Pediatrics ◽

10.5812/ijp.112780 ◽

2021 ◽

Vol 31 (4) ◽

Author(s):

Ziba Mosayebi ◽

Tahereh Esmaeilnia ◽

Vafa Ghorban Sabagh ◽

Amir Naddaf ◽

Setareh Sagheb ◽

...

Keyword(s):

Cohort Study ◽

Respiratory Distress ◽

Clinical Features ◽

Laboratory Data ◽

Clinical Manifestations ◽

Clinical Feature ◽

X Rays ◽

Multicenter Cohort Study ◽

Multicenter Cohort ◽

Gastrointestinal Problems

Background: Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, causing a significant public health disaster. Objectives: The present study aimed to evaluate the clinical features and laboratory data of neonates born to mothers with COVID-19. Methods: A retrospective multicenter cohort study was conducted from March 20 to September 5, 2020, on all neonates born to mothers with positive real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 or clinically suspected COVID-19. Neonates enrolled in this study were from five different hospitals affiliated with the Tehran University of Medical Sciences. All the newborns were tested for SARS-CoV-2 using nasopharyngeal swabs during the first 24 - 48 hours of life, and a second-time swabbing was performed as indicated at subsequent visits. All categorical data were manifested as frequency (%), and continuous data were shown as mean ± SD. Results: Forty-four neonates born to 39 infected mothers were evaluated during the study period. Nineteen women had complications during pregnancy, including hypertensive disorders, gestational diabetes, preterm labor, etc. Besides, 54.5% of the neonates were born preterm. The mean gestational age and birth weight were 35.11 ± 4.01 weeks and 2,567 ± 898 g, respectively. Fifteen (34.1%) neonates were symptomatic at birth, and during the observation, more neonates became symptomatic. Finally, 27/44 (61.3%) neonates became symptomatic, and 17/44 remained asymptomatic. The most common clinical manifestations were respiratory distress (77.7%), followed by fever or hypothermia (18.5%), gastrointestinal problems (14.8%), and neurologic findings (3.7%). Also, the most common clinical feature of eight neonates with positive RT-PCR was respiratory distress, followed by neurologic symptoms, temperature instability, and gastrointestinal disorder, in sequence. Few abnormalities were seen in laboratory findings. Chest X-rays were abnormal in 22.2% of the neonates. Conclusions: The SARS-CoV-2 infection during pregnancy may cause severe maternal and neonatal morbidities. Neonates with positive SARS-CoV-2 may demonstrate a spectrum of clinical features. The most common feature of neonates born to mothers with COVID-19 was respiratory distress.

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