Prevalence of SARS-CoV-2 positivity in infants with bronchiolitis: a multicentre international study

Background Bronchiolitis is the leading acute respiratory tract infection in infants during the winter season. Since the beginning of the SARS-CoV-2 pandemic, a reduction in the number of bronchiolitis diagnoses has been registered. Objective The present study aimed to describe the incidence and clinical features of bronchiolitis during the 2020-2021 winter season in a large cohort of children in Europe and Israel, and to clarify the role of SARS-CoV-2. Setting, patients, interventions We conducted a multicentre observational cross-sectional study in 23 paediatric emergency departments in Europe and Israel. Clinical and demographic data about all the cases of infants diagnosed with bronchiolitis from 1 October 2020 to 30 April 2021 were collected. For each enrolled patient, diagnostic tests, treatments and outcomes were reported. Main outcome measures The main outcome was the prevalence of SARS-CoV-2-positive bronchiolitis. Results Three hundred and fourteen infants received a diagnosis of bronchiolitis during the study period. Among 535 infants who tested positive for SARS-CoV-2, 16 (3%) had bronchiolitis. Median age, male sex predominance, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. Rhinovirus was the most common involved pathogen, while respiratory syncytial virus (RSV) was detected in one case. SARS-CoV-2 bronchiolitis had a mild clinical course, with one patient receiving oxygen supplementation and none requiring paediatric or neonatal intensive care unit admission. Conclusions During the SARS-CoV-2 pandemic, a marked decrease in the number of bronchiolitis diagnoses and the disappearance of the RSV winter epidemic were observed. SARS-CoV-2-related bronchiolitis was rare and mostly displayed a mild clinical course.During the SARS-CoV-2 pandemic, very few infants with SARS-CoV-2 had bronchiolitis and mostly displayed a mild clinical course. Overall there was a marked decrease in bronchiolitis cases, indeed the RSV winter epidemic did not occur

Artrite settica dell\u2019anca in epoca neonatale: una sfida diagnostica

INTRODUZIONE: L\u2019artrite settica dell\u2019anca \ue8 una condizione piuttosto rara in et\ue0 pediatrica che pu\uf2 svilupparsi in seguito a diffusione ematogena, estensione flogistica da sito adiacente e/o inoculazione microbiologica diretta. CASO CLINICO: Descriviamo il caso di un neonato di 6 giorni di vita giunto alla nostra attenzione per comparsa improvvisa di irritabilit\ue0 e ipomotilit\ue0 degli arti inferiori. Nato a termine, da parto eutocico, in gravidanza normodecorsa, con tamponi vaginali sconosciuti. Peso neonatale ed indice di Apgar nella norma. Periodo perinatale regolare; lieve instabilit\ue0 dell\u2019anca destra alla manovra di Ortolani-Barlow. Alla Ia valutazione in PS il piccolo si presentava apiretico, vivace e reattivo, con parametri vitali nella norma. L\u2019anca destra appariva flessa, extra-ruotata e dolente alla mobilizzazione passiva ed attiva. L\u2019emocromo e il dosaggio degli indici di flogosi non risultavano dirimenti e all\u2019Rx degli arti inferiori non si evidenziavano rime di frattura. Per il riscontro all\u2019ecografia delle anche di versamento intra-articolare veniva avviata terapia antibiotica endovenosa ad ampio spettro (con amikacina e ceftazidime). La RMN, eseguita in seguito, confermava la presenza di coxite destra, con interessamento capsulare, e poneva indicazione a drenaggio eco-guidato. La coltura del liquido sinoviale rivelava la crescita di S. epidermidis. Nella settimana successiva si assisteva ad un netto miglioramento delle condizioni cliniche con concomitante risoluzione ecografica del versamento articolare. La terapia antibiotica veniva, quindi, proseguita a domicilio per un totale di 10 giorni in assenza di sequele a distanza. CONCLUSIONI: Una diagnosi precoce (basata sui criteri di Morrey) ed un trattamento tempestivo (con antibiotici permette la risoluzione dell'artrite settica in et\ue0 pediatrica

Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country

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The Use of Lung Ultrasound to Monitor the Antibiotic Response of Community-Acquired Pneumonia in Children: A Preliminary Hypothesis

Community-acquired pneumonia (CAP) is associated with high morbidity and mortality among children worldwide. Over the last 10\u2009years, lung ultrasound (US) has been widely studied as an alternative diagnostic tool for adult and pediatric CAP with excellent results. In this case series, we describe clinical and laboratory results as well as detailed lung US findings in 6 children with CAP, showing the potential use of lung US in monitoring the response to antibiotic therapy

Characteristics of Children and Adolescents with Hyperinsulinemia Undergoing Oral Glucose Tolerance Test: A Single-Center Retrospective Observational Study

The aim of this study was to evaluate a potential correlation between results of the oral glucose tolerance test (OGTT) and the auxological/metabolic parameters in a cohort of overweight patients assessed for suspicion of hyperinsulinism. We analyzed 206 patients, comparing those with insulin peak below (nonhyperinsulinemic) and over 100 uIU/mL (hyperinsulinemic) at the OGTT. We found a significant difference in weight (p = 0.037), body mass index (BMI, p p p = 0.001), hip circumference (p = 0.001), and waist-to-height ratio (WHtR, p = 0.016) between the two groups. Analyzing the median insulin value during OGTT in the whole population, a weakly positive correlation emerged with weight SD (p rho = 0.292) and a moderate positive correlation with BMI SD (p rho = 0.323). We also found a weakly positive correlation with waist circumference (p = 0.001; rho = 0.214), hip circumference (p = 0.001; rho = 0.217), and WHTR (p = 0.016; rho = 0.209) and a moderate positive correlation with the HOMA index (p rho = 0.683). The median insulin value correlates with high triglyceride (p rho = 0.266) and triiodothyronine values (p = 0.003; rho = 0.193) and with low HDL values (p rho = −0.272). In clinical practice the interpretation of laboratory and anthropometric parameters could predict the level of insulin, highlighting also a possible underlying diagnosis of insulin resistance and/or hyperinsulinemia without performing an OGTT

Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone. impact on patient management and training program for community health officers

Purpose: Point-of-care ultrasound (POCUS) has been shown to have unique potential in low-income countries. Physicians and other healthcare providers can perform effective scans after a short period of training. This study aimed to evaluate indications and utility of ultrasonography as the main imaging service in a poor rural sub-Saharan region of Africa. Second, it evaluated the effect of a short training on POCUS for non-physician health providers and their agreement with a group of Italian physicians. Methods: This study was undertaken in Lokomasama-a chiefdom of Sierra Leone-between January and February 2019. Based on clinical indications, ultrasound findings were evaluated with respect to the initial diagnostic hypothesis. Volunteer doctors conducted a theoretical-practical training of two community health officers (CHO) on chest and abdominal POCUS and E-FAST protocol. The evaluation of the achieved technical skills was obtained with a numeric score. Inter-observer agreement concerning ultrasound diagnosis based on clinical indications was assessed. Results: A total of 196 consecutive patients underwent ultrasound examination. POCUS findings were in keeping with the clinical diagnosis in the 49.5%. POCUS changed the initial diagnosis in 17% of cases. After training, E-FAST and POCUS knowledge score was 90% and 83%, respectively. An excellent inter-observer agreement (0.88) was found between CHOs and physicians. Conclusion: POCUS represents a powerful diagnostic tool in a low-income country that may improve the patient management. Training of non-physician health providers is doable and may improve healthcare management in resource-limited settings

Nurses’ Perceptions of the Quality of Procedural Sedation in Children Comparing Different Pharmacological Regimens

Nurses play a pivotal role during pediatric procedural sedation and their perspective is an important indicator for the quality of care. The aim of this study is to examine nurses’ satisfaction comparing four different pharmacological regimens used for pediatric sedation outside of the operating room. A prospective observational study was conducted in a third-level pediatric teaching hospital, involving all the nurses with experience in the field of pediatric procedural sedation. A 13-item survey was used to assess the level of nurses’ satisfaction for the quality of sedation with four different analgesic–sedative drugs. Fifty-one questionnaires were completed by pediatric nurses, with a median length of experience of 10 years. Regarding the overall quality of the sedation, the highest median satisfaction scores were observed for propofol (8, IQR 7–9), dexmedetomidine (8, IQR 6–8) and midazolam (8, IQR 7–9). Ketamine (5, IQR 3–7) displayed the lowest score. When asked to rate their level of perceived safety, nurses gave high scores to all the four drugs studied, with no statistically significant difference between them. Non-pharmacological techniques during procedural sedation were judged as important by 38 (74.5%) nurses. According to this sample of pediatric nurses, the best quality of procedural sedation in children outside of the operating room is obtained with propofol, dexmedetomidine and midazolam. During procedural sedation, nurses feel safe overall, regardless of the pharmacological regimen used. Moreover, they highlighted the relevance on non-pharmacological approaches in the preparation of the child for the procedure

Lung ultrasound in infants with bronchiolitis

Lung ultrasound (LUS) is nowadays a fast-growing field of study since the technique has been widely acknowledged as a cost-effective, radiation free, and ready available alternative to standard X-ray imaging. However, despite extensive acoustic characterization studies and documented medical evidences, a lot is still unknown about how ultrasounds interact with lung tissue. One of the most discussed lung artifacts are the B-lines [in all ages] and the subpleural consolidations (in young infants). Recently, LUS has been claimed to be able to detect pneumonia in infants with bronchiolitis, although this can be an overestimation due to the peculiar physiology of small peripheral airways of the pediatric lung (particularly in neonate/infants). Distinguishing consolidations from atelectasis in young infants with bronchiolitis can be challenging and those criteria well defined for adults and older children (size and bronchogram) cannot easily translated in this specific subset. Therefore, if decades of studies clearly defined the low risk of SBI in bronchiolitis, we need to be careful before stating that LUS may confirm pneumonia in such a high number of cases and, importantly, new and promising techniques such as LUS should give us new insights bringing us to improvements and not back to overuse of antibiotics. More studies are surely need on this topic

Lung Ultrasound in Infants With Respiratory Infections: More Important the Age or the Pathogen?

No abstract availabl