Diarrhea Is a Hallmark of Inflammation in Pediatric COVID-19

: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pathogen with enteric tropism. We compared the clinical, biochemical and radiological features of children hospitalized for acute SARS-CoV-2 infection, classified in two groups based on the presence of diarrhea. Logistic regression analyses were used to investigate the variables associated with diarrhea. Overall, 407 children were included in the study (226 males, 55.5%, mean age 3.9 ± 5.0 years), of whom 77 (18.9%) presented with diarrhea, which was mild in most cases. Diarrhea prevalence was higher during the Alpha (23.6%) and Delta waves (21.9%), and in children aged 5-11 y (23.8%). Other gastrointestinal symptoms were most commonly reported in children with diarrhea (p < 0.05). Children with diarrhea showed an increased systemic inflammatory state (higher C-reactive protein, procalcitonin and ferritin levels, p < 0.005), higher local inflammation as judged by mesenteric fat hyperechogenicity (adjusted Odds Ratio 3.31, 95%CI 1.13-9.70) and a lower chance of previous immunosuppressive state (adjusted Odds Ratio 0.19, 95%CI 0.05-0.70). Diarrhea is a frequent feature of pediatric COVID-19 and is associated with increased systemic inflammation, which is related to the local mesenteric fat inflammatory response, confirming the implication of the gut not only in multisystem inflammatory syndrome but also in the acute phase of the infection

Pediatric Nutrition in Different Countries

In this Special Issue, titled “Pediatric Nutrition in Different Countries”, we give concise and straightforward information on the nutritional habits of children in different countries worldwide [...

Cleft Palate and Aortic Dilatation as Clues for Loeys-Dietz Syndrome

Loeys-Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1-LDS6, respectively). Delay in diagnosis of Loeys-Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation

Intussusception and appendicitis: What comes first?

Intussusception and acute appendicitis are two different causes of acute abdomen that potentially require surgery. The clinical presentation can be similar in both diagnoses with symptoms including abdominal pain, vomiting, diarrhea, and fussiness but these two concern a pediatric population of different ages. We describe an uncommon CASE combining appendicular intussusception with concurrent acute appendicitis. A 27-month-old boy presented with 3 day of colicky intermittent abdominal pain, non-bilious vomit and low-grade fever. After the failure of air enema decompression, the child underwent a surgical procedure

A rare case of mesenteric chylous cyst in infant: case report and review of literature.

The occurrence of a mesenteric cyst (MC) is common in adults while in children and in infants is rare. In adults mesenteric cysts are often asymptomatic and discovered incidentally; however, in children they commonly present with symptoms of abdominal pain or distension with fever and leucocytosis. We report on a rare case, in our experience, of Mesenteric Chylous cyst (MCC) in an infant with signs and symptoms of intestinal obstruction. Discussion of literature is also reported

Midgut volvulus and meconium peritonitis induced non-immune hydrops

Meconium peritonitis (MP) is a rare cause of nonimmune hydrops and only few of those cases have been reported in literature. Here is to report on a case of FH secondary to perforated midgut volvulus and MP with special interest in the discussion of pathophysiology and clinical strategies. We report on a preterm male neonate diagnosed with FH at 29th week of gestational age (WGA) and EXIT at 30 WGA. In addition, he presented with abdominal mass, respiratory distress syndrome and hypoglycemia. Emergent endotracheal intubation and mechanical ventilation rescued the baby. All maternal and infant viral panel, Toxoplasmosis, Sars-Covid 2 and indirect/direct coombs tests were negative. . At laparotomy, we found a midgut volvulus interesting nearly all the jejunum but sparing the ileum which appeared hypoplastic. One of intestinal loop was completely perforated with diffuse MP. Distal to the first jejunal loop, the jejunum appeared necrotic and then resected with bowel exteriorization (terminal jejunostomy and ileostomy). The postoperative course was complicated by worsening of respiratory distress, acute tubular necrosis and renal failure unresponsive to medical therapy and fatal outcome. In conclusion, we believe that hydrops secondary to midgut volvulus and meconium peritonitis has its own pathophysiological and clinical characteristics that make this disease at high risk of unfavourable outcome when compared with prenatal cases of midgut and/or meconium peritonitis without hydrops