Clinical Pediatric Screening for COVID-19

Background: Due to the increasing prevalence of covid-19, the World Health Organization declared on 30 January 2020, the spread of the new coronavirus as a 6th public health emergency of international concern. Objectives: To assess the extent of the disease in the pediatric population in our region, we conducted a clinical pediatric screening for Covid-19 and evaluated factors that affected its manifestation in children. Methods: In this study, 474761 children under 19 years of age were screened in two phases. In the first phase, 680 cases were considered as suspect and referred to the health centers, where the second phase of screening took place. Finally, 230 probable cases were referred to specialized centers for further investigation. Results: Almost all of the cases had pneumonia and symptoms of shortness of breath, cough, and fever over 38°C (56.7%). Other clinical symptoms included hypotension (17.4%), Hemoptysis (16.1), sore throat (11.6%) and difficult breathing (6.7%). 26% of patients had a history of chronic disease (mainly pulmonary and cardiac). There was a statistically significant relationship between the probable causes and the symptoms of the disease (P < 0.05), between age and probable cases (P < 0.05), and between death and underlying disease (P < 0.05). However, of all the cases, only 15 (6.5%) had a positive PCR test, 39 patients were hospitalized (17%), 173 cases (75%) received outpatient treatment and 18 cases (7.8%) died. Conclusions: Children with shortness of breath, cough, pneumonia, fever over 38 and underlying disease are suspicious for Covid-19 and should be hospitalized to be evaluated with laboratory tests.

No Benefit of a Pediatric Screening in Discovering Reduced Visual Acuity in Children: Experiences from a Cross-Sectional Study in Germany

Background: The newly introduced German pediatric screening examination at the end of the third year of life (U7a) incorporates visual function testing in particular; there is no ophthalmic screening during childhood in Germany. The purpose of this study is to investigate the relationship between participation in U7a and visual function at the preschool health examination (PHE) in the sixth year of life. Methods: This study evaluated PHE data from school enrollment years 2009/2010 to 2014/2015 of Rhineland-Palatinate, Germany. Visual acuity (VA) at PHE was assessed with Rodenstock visual acuity test device (tumbling E) wearing glasses if present. The relationship between participation in U7a and VA <0.7 at PHE was calculated for reduced monocular and binocular VA using multiple logistic regression adjusted for potential confounders. Results: Data from 189,704 children (91,041 girls) in 35 out of 36 districts were included. The first children to participate in U7a were enrolled in 2011/2012 school year. In total, 90,339 children (47.6%) had U7a before PHE, while 99,365 (52.4%) had not. VA <0.7 in at least one eye was measured at PHE in 8429 (4.4%) children, and in both eyes in 4345 (2.3%) children. Participation in U7a was not associated with VA <0.7 at PHE (odds ratio 0.99; 95% confidence interval: 0.94–1.04). Conclusions: The proportion of children with VA <0.7 at PHE was high. No beneficial effect of newly introduced German U7a pediatric screening examination was found for reduced VA at PHE.

Predicting youth diabetes risk using NHANES data and machine learning

Type 2 diabetes has become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably identify diabetes risk and prevent the adverse effects of this serious disease are only available for adults, not for youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES), to examine the performance of a well-known adult diabetes risk self-assessment screener and published pediatric clinical screening guidelines in identifying youth with pre- diabetes/diabetes (pre-DM/DM) based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the adult screener/pediatric screening guidelines and biomarker diagnostic criteria by conducting comparisons using the overall data set and sub-datasets stratified by sex, race/ethnicity, and age. While the pediatric guidelines performed better than the adult screener in identifying youth with pre-DM/DM (sensitivity 43.1% vs 7.2%), both are inadequate for general deployment among youth. There were also notable differences in the performance of the pediatric guidelines across subgroups based on age, sex and race/ethnicity. In an effort to improve pre-DM/DM screening, we also evaluated data-driven machine learning-based classification algorithms, several of which performed slightly but statistically significantly better than the pediatric screening guidelines.

Establishing a Normative Database for Quantitative Pupillometry in the Pediatric Population

Background Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting. Methods Pupillometry was obtained prospectively for consecutive, normal patients <18 years old being evaluated by Lurie Children’s Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark. Results 196 eyes of 101 participants (42.6% male, ages 1–17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1–8.1 mm 95% CI); MIN was 4.7 mm (3.1–6.1 mm 95% CI); CON was 30% (17–42% 95% CI); LAT was 230 milliseconds (160–300 ms 95% CI); ACV was 3.70 mm/sec (2.21–5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38–1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2% and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤1.0 mm, respectively. Conclusions Quantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON. Keywords: Pupillometry; pupils; pediatric screening; normative

Establishing a Normative Database for Quantitative Pupillometry in the Pediatric Population

Purpose Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population. Methods Pupillometry was obtained prospectively for consecutive, normal patients <18 years old being evaluated by Lurie Children’s Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark. Results 196 eyes of 101 participants (42.6% male, ages 1–17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1–8.1 mm 95% CI); MIN was 4.7 mm (3.1–6.1 mm 95% CI); CON was 30% (17–42% 95% CI); LAT was 230 milliseconds (160–300 ms 95% CI); ACV was 3.70 mm/sec (2.21–5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38–1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2% and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤1.0 mm, respectively. Conclusions Quantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON. Keywords: Pupillometry; pupils; pediatric screening; normative