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Abstract Body

It is now established that neurodevelopmental disorders have their roots in early life stress and brain injury. Sleep represents the predominant behavioural state during neonatal age and undergoes remarkable changes from intrauterine life to adulthood, which are correlated with stages of Central Nervous System maturation. There is evidence in literature that poor quality of neonatal sleep (less total sleep time, frequent awakenings, alterations in spectral values) is associated with negative cognitive and language outcomes, as well as with less concentration in infancy and early toddlerhood. Data has mainly been drawn from studies conducted in premature neonates and causes of sleep disorders are usually due to factors associated with prematurity itself (delayed maturation, impaired neuronal connectivity) or due to co-morbidities (infection, ischaemia); differences between neonates with appropriate for age weight and neonates with intrauterine growth restriction have also been identified.

In terms of therapeutic interventions, skin-to-skin contact, earmuffs, cycled lighting and nesting-swaddling have been found to increase total sleep time and promote sleep organisation. In parallel, the innovative approach of sensory stimulation and boosting of slow-wave sleep (in older age groups) has been shown to positively affect declarative memory.

Future research projects are expected to explore ways to modulate parameters and stages of neonatal sleep, through sensor stimulation, in order to promote learning process and improve cognitive outcomes. At the same time, the pathways of learning and memory establishment at neonatal age need to be further investigated and the development of “sleep culture” in Neonatal Intensive Care Units to be prioritised.

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Congenital heart disease is associated with poor growth, delayed motor and language skills development and increased length of hospital stay. Poor nutritional status at the time of surgery is associated with an increased paediatric intensive care unit length of stay (PICU-LOS), suggesting a low WAZ at the time of surgery may impact on PICU-LOS. Infants with complex heart defects including those with duct dependent lesions may be at increased risk of necrotizing colitis during the pre- and peri-operative period. Enteral feeding in this period is safe and well tolerated with adequate observation and monitoring, and when used along with an enteral feeding protocol is associated with improved nutritional adequacy. The use of a nutritional pathway before surgery has been shown to improve growth outcomes at 1 year of age, and reduce length of PICU LOS.

This talk will cover aspects related to:

To the impact of nutritional status on clinical outcomes

To review pre-operative nutrition support and the associated risk of necrotising enterocolitis

To review the type of enteral nutrition support during the peri-operative period

To review the use of nutritional pathway as part of pre-habilitation

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Revised presentation title: Nutrition of critically ill children and neonates

Assessment of vitamin and trace element status (VTE) is important in the clinical management of the critically ill child. Approaches includes clinical examination, dietary assessment, and measurement of direct and indirect biomarkers of VTE in biological samples. Use of biomarkers is the most common approach to assess VTE status in routine practice but in the presence of systemic inflammatory response and in the absence of appropriate paediatric reference intervals, interpretation of biomarker results might be challenging and potentially mislead clinical practice.

The nutritional management of critically ill neonates varies widely, and controversies exist in regard to when to initiate nutrition, mode of feeding, energy requirements, and composition of enteral and parenteral feeds. More studies on this topic are clearly needed, but if critical illness is suspected, the diagnosis should be establish by assessing clinical and biological markers. Minimal enteral feeding (MEN) should be initiated within 48 h if feasible. Energy and macronutrient intakes should be reduced during the acute phase. Nutrient intakes should be gradually advanced when the clinical state and the inflammatory response are resolving. The transition from the catabolic to the anabolic phase seems to start between 3-7 days after the insult, but may occur earlier (24-48 h) in preterm infants or neonates with less illness severity or be delayed in neonates with severe injury insults. During the recovery phase, nutritional supply in the upper range of recommendations can be given to cover cumulative deficits.

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Introduction: The social distancing that has been imposed upon children caused massive upheaval to children’s lives. Aim: To analyze the children´s anxiety in the social distancing during a global pandemic. Method: Cross-sectional study using nonprobability sampling methods. Conducted in 2020 in the Botucatu Medical School, using an online survey. We included children in the social distancing between 6 and 12 years old. The instruments Children´s anxiety questionnaire (CAQ, score 4 to 12) and Numerical Rating Scale (NRS, scores 0-10) were used to measure anxiety. CAQ assesses the domains of happy/content; calm/relaxed; tense/nervous; afraid/worried, and answers range a lot, some, and a little. Results: We enrolled 157 girls and 132 boys, with a mean age of 8.84 (± 2.05). For happy, the rates of a lot, some, and a little were: 34.6, 51.6, and 13.8% respectively. For calm: 30.5, 51.2, and 18.3%. For tense: 56.5, 30.4, and 13.1%. And for afraid: 56.4, 30.4, and 13.1%. Median CAQ and NRS scores were 6.9 and 4.9. On univariate analysis, girls had a higher CAQ score than boys, but not for NRS. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents, more persons living together in home, and education level of parents or guardians. Conclusions: Despite low rates of children reporting worry and fear, the majority were not very happy and calm.

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Background and aims: The aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes.

Methods: This retrospective, single-center, observational study was conducted in a french pediatric intensive and high-dependency care unit (PICU and HDU) between the beginning of the COVID-19 french epidemic till the end of the main epidemic spike. All patients, aged from 1 month to 18 years, admitted in PICU and HDU for confirmed or highly suspected SARS-CoV-2 infection were included.

Results: Twenty-eight (28) children were included. Comorbidities were present in 18 patients (64%), mainly immuno-hemato-oncological (n = 8) and neurological (n = 5). COVID-19 diagnosis was primarily confirmed by nasopharyngeal and throat swabs (25 patients) or was highly suspected by chest CT-scan (3). The main reason for PICU and HDU admission was hypoxemic respiratory failure. Acute respiratory distress syndrome occurred in 8 patients (29%). Other complications were also frequent (associated infections and neurologic complications, respectively 29 and 11%). The mean duration of PICU and HDU stay was 5 days (1 – 45 days). Five children died, of whom three were without past medical history.

Conclusions: this report highlight some forms of SARS-Cov-2 infections in children. Healthcare personnel need to be aware that children may also have severe cases of this disease, although less common in adults.

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Background and aims

The COVID-19 pandemic has occasioned the collapse of the Spanish national health system. Two completely different clinical diseases: adults with acute respiratory distress syndrome (ARDS) and children with toxic shock syndrome (TSS). The objective is to describe their characteristics and outcomes.

Methods

Prospective observational study. Patients admitted to the Paediatric Intensive Care Unit from March to May 2020 with a positive COVID-19 have been included.

Results

In total, 16 adults with ARDS were admitted. Median age 32years (IQR 23.3-41.5), 11 (68.8%) with relevant previous pathology: asthma (n=5;31%), obesity (n=7;43.7%), hypertension (n=2;12.5%). Of them, 13(81.2%) required mechanical ventilation (MV); median PEEP was 13(IQR 10.5-14.5), and median days under MV, 11(7.5-14). Ten (62.5%) required prone position and 5(31.3%) recruitment manoeuvres. Inotropic treatment needed in 6(37.5%), with a median inotropic score of 5(IQR 5-10). Afterwards, 1 patient had pulmonary thromboembolism.

Three previously healthy children presented a TSS. Median age 13 years (IQR 8-15). All needed inotropes due to the shock, with an inotropic score of 30(IQR 27.7-30). Two required MV (but with median PEEP of 6), and 1 non-invasive ventilation.

Differences were found in biomarkers, higher in children: MR-pro-adrenomedullin 1.7vs. 0.78nmol/L, p=0.012, procalcitonin 6.8 vs. 0.19 ng/mL, p=0.004, and C-reactive protein 333.9 vs. 146mg/L, p=0.008.

Conclusions

Adults and children seem to have different clinical presentations related to COVID-19. The adults presented severe ARDS, requiring mainly respiratory support while children presented toxic shock, needing haemodynamic support. Biomarkers are different depending on the disease; thus, they might be helpful.