Infections in a Tertiary Care Pediatric Center in Southern Poland during the SARS-CoV-2 Pandemic

The worldwide surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic and led governments to control spread of the virus and provide care for the population affected by the infection. Although, in children, COVID-19 is usually asymptomatic or mild (except PIMS), the pandemic affected the whole socioeconomic system and led to the overwhelming of healthcare facilities. We report retrospective observations of the prevalence of various infectious diseases during the SARS-CoV-2 pandemic in a tertiary multidisciplinary pediatric center in Southern Poland. We retrospectively evaluated the impact of the SARS-CoV-2 pandemic on the number of other infections diagnosed in a pediatric tertiary care referral center. Our analysis included the period from the beginning of February to the end of April 2020 (spring pandemic wave), and from the beginning of September to the end of November 2020 (autumn pandemic wave). We compared them to the appropriate periods of 2019. The evaluation included blood, urine, stool and lover respiratory tract cultures as well as virological investigations. Additionally, the costs of antibiotics and antifungal drugs in selected departments were assessed. Our analysis showed considerable reduction in the majority of common infections except for influenza A and B. The microbiological data correspond with economical summary of antibiotic costs, which were significantly lower during the pandemic. One exception was the number of positive blood cultures, which increased even though the overall number of tests was lower. A general reduction of the number of infections diagnosed in children could result from the implemented preventative measures associated with the pandemic and the generally increased awareness of the risk of infection among parents and guardians. The treatment of the most serious diseases continued as it did before the pandemic. To our knowledge, this study is the first attempt to assess the impact of the COVID-19 pandemic on the prevalence of infections in a large pediatric center. Further research on the impact of the COVID-19 pandemic on the healthcare systems is necessary.

P026 Efficacy and safety of Etanercept for the treatment of Juvenile Idiopathic Arthritis

Background Etanercept (ETN) is the first anti-TNF to have obtained FDA approval in 1999 for juvenile idiopathic arthritis (JIA) refractory to methotrexate. Currently, the indications of ETN cover the polyarticular JIA, the extended oligoarticular, and enthesitis-related arthritis. To assess the efficacy of Etanercept, as well as its tolerance in JIA. Material and methods We carried out a retrospective study of children with JIA according to the criteria of the ILAR classification and treated with Etanercept at the pediatric center of the CHU de Sétif since 2015. Nineteen children were included and considered to 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years on the criteria epidemiology, the efficiency criteria (joint Scores, uveitis, ESR, CHAQ), and the occurrence possible side effects. We defined the improvement of 30% (ACR 30), 50% (ACR 50), 70% (ACR 70), 90% (ACR 90), and 100% (ACR 100) as the improvement of minus 3 criteria out of 6 of 30%, 50%, 70%, 90%, 100%; patients must not have a worsening of > 30% of any of the 6 criteria. Results The epidemiological features were the following: 12 girls and 7 boys, 10 present polyarticular form, 6 present oligoarticular form, 2 cases with psoriatic arthritis, and a single case of enthesitis-related arthritis. ACR 30 is obtained in 75%, 84%, 88% of cases at 3 months, 6 months, and 1 year, respectively. The strongest responses were obtained in polyarticular, oligoarticular, and enthesitis-related arthritis. Complete remission was maintained in the majority of patients for varied durations depending on the follow-up. Furthermore, no clinical or biological adverse effects were noted. Conclusion The Etanercept has been dramatically effective in children with juvenile idiopathic arthritis, especially in the polyarticular subtype, oligoarticular, and enthesitis-related arthritis. Its overall tolerance is very good.

Clinical and hematological features of childhood immune thrombocytopenia at Pediatric Center of Hue Central Hospital

Background: Immune thrombocytopenia (ITP) is the most common of the hemorrhagic diseases caused by thrombocytopenia in children. It usually occurs between the ages of 5 and 7 years old and at both sexes. It is difficult to predict ITP basing on bleeding because some severe thrombocytopenia cases have slight purpura or ecchymoses. This study aims to describe the clinical and hematological features of childhood immune thrombocytopenia Methods: This was a cross - sectional study. Patients were stratified according to age (0 to 15 years) and diagnosed ITP at the Pediatric Center of Hue central Hospital. Results: From May 2020 to March 2021, we identified 42 children diagnosed with idiopathic thrombocytopenia. Newly diagnosed ITP was the most common (66.7%) followed by chronic ITP (26.2%) and persistent ITP (7.1%). There was a slight predominance of boys to girls with the male - to - female ratio was 2:1. However, this ratio was dependent on ITP phases. The highest prevalence of immune thrombocytopenia was found under 6 years old. Children in this study usually had a history of preceding infection or vaccination. Natural hemorrhage was 83.3% (skin 95.2%). The most common type of cutaneous bleeding was petechiae (83.3%). Mild to moderate hemorrhages were dominant. Newly diagnosed ITP had less severity of hemorrhage than persistent and chronic ITP. Most children did not have a fever, hepatomegaly, splenomegaly, and lymphadenopathy. The majority of children seem to have severe thrombopenia (66.7%), but the number of platelets was not related to the severity of bleeding. Mean platelet volume was normal. Conclusions: Newly diagnosed ITP was the most common. There was a little clinical and hematological features difference between the ITP phases.

Anti-N-Methyl-D-Aspartate receptor encephalitis in a child

Background: Anti-N-methyl-D-aspartate receptor encephalitis is a rare autoimmune disease characterized by severe neurological and psychiatric symptoms and difficult to diagnose. We report a case of Anti-N-methyl-D-aspartate receptor encephalitis diagnosed at the Pediatric Center of Hue Central Hospital. Case report: A 3½ - year - old girl with previously normal psychomotor development developed behavioral problems and speech impairment 2 week ago. From the onset of symptoms, choreic movements gradually appeared. Hematological, neuroradiological, and neurological examinations were negative; however, her symptoms worsened and treatment with methylprednisone was started. Although her choreic movements improved, her neuropsychological and behavioral symptoms still continued. Anti-N-methyl-Dspartate receptor antibodies in cerebrospinal fluid were detected. The second dose of methylprednisone and then immunoglobulins was administered. After several weeks of treatment, she was well recovered with a progressive improvement in language and behavior. Conclusions: Anti-N-methyl-D-aspartate receptor encephalitis in pediatric patients can present initially with neuropsychological and behavioral symptoms.