The Significance of Lung Ultrasonography in Children with COVID-19

Introduction:The infection of new Coronavirus disease-2019 (COVID-19) continues to affect both adults and children worldwide. Although there are studies of adult patients with COVID-19 that defined ultrasound findings, there is limited data available on the diagnostic use of ultrasonography in children. This study is aimed to evaluate the results of bedside lung ultrasonography (LUS) performed in pediatric patients with COVID-19.Methods:The study included pediatric patients who were diagnosed with COVID-19. All lung areas were visualized on LUS and evaluated together with demographic, clinical, and laboratory data, and chest X-ray (CXR) findings.Results:An evaluation was made of 102 pediatric patients, comprising 54 girls and 48 boys with a mean age of 9.65±4.78 (min 35 days-max 17) years. Forty-six percent of the patients had respiratory system symptoms, 36% were asymptomatic, and 18% had symptoms other than in the respiratory system. Pathologic findings were determined on CXR in 36% of patients, and on LUS in 57%. The difference in the detection rate of pathologic findings between LUS and CXR was statistically significant (p=0.001). Pathology was observed on LUS in 29 of 65 patients with normal CXR. The sensitivity rate for detecting pathology in patients with respiratory symptoms was 49% on CXR and 77% on LUS (p=0.001).Conclusion:We determined that the sensitivity of LUS is higher than CXR in demonstrating lung involvement in patients with COVID-19 with respiratory symptoms. LUS may be helpful in the evaluation of pediatric patients with COVID-19 but more studies are needed to prove its feasibility in children

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis

AIM: To analyze the frequency of pleural effusion and the effect on prognosis in children with acute bronchiolitis. METHODS: A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients'age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3(rd )and 7(th )day of the treatment. RESULTS: Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors. CONCLUSIONS: This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey

Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures

Outcome Of Out-Of-Hospital Cardiopulmonary Arrest In Children: A Multicenter Cohort Study

The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1-15) min, while it was 15 (5-40) min for the remaining patients (p<0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p<0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.Wo

The First National Data Of Turkish Pre-Hospital Emergency Care For Children: Epidemiology, Clinical Characteristics, And Outcomes

Background and Objectives: The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients' clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients' outcomes following transport were also investigated. Methods: This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought. Results: A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were delivered to pediatric emergency departments without notification calls. Although notification calls were more likely given for particularly critically ill children, for non-urgent conditions transfer calls were less common (60.8% vs 23.5%, respectively; p < 0.001). A majority of transports were performed for trauma patients (20.5%), neurological issues (20%), and toxicological emergencies (13.8%). While parents prefer using the ambulances for medical emergencies, physicians prefer it for mainly traumatic and toxicological emergencies. In total, 65% of the patients received at least one intervention, and 18 patients needed immediate life-saving interventions (intubation, cardiopulmonary resuscitation, etc.) but they did not receive it. Mortality occurred in nine patients. If the health care providers were paramedics, they were more likely avoided by performing any intervention in critically ill children (p < 0.001). A majority of the procedures performed in children were older than 12 months (p < 0.001). Conclusion: This study presents comprehensive epidemiological and outcome data for pediatric patients transported by the national emergency medical service system in Turkey. Non-urgent calls were more likely made by parents, physicians avoided making NCs, and paramedics also avoided performing any intervention when they were transporting children.WoSScopu

Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study

Background. The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated

Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study

The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median {[}interquartile range (IQR)] age was 22 (5-54) months; 60.4\% of the patients were males, and 44\% were younger than one year of age. The witnessed arrest rate was 75.8\% (138/182) and the rate of bystander CPR was 13.9\% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9\%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1-15) min, while it was 15 (5-40) min for the remaining patients (p<0.001). The ROSC rate was 94.9\% in patients who underwent CPR for less than 20 min and 22\% in patients requiring CPR longer than 20 min (p<0.001). Survival to hospital discharge was 14.3\%. Of these patients, 57.7\% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results

COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases.

Background: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical out-comes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.Methods: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific anti-bodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of con-tact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.Results: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.Conclusion: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.(c) 2022 Elsevier Inc. All rights reserved