Backgrounds:

We aim to describe outcomes (focusing on hearing and neurological findings) and transfer of maternal antibodies in infants born from mothers with SARS-CoV-2 infection during pregnancy.

Methods:

Observational prospective study performed in a tertiary hospital in Madrid (Spain). Infants born from mothers with SARS CoV-2 infection during pregnancy from March to September 2020 were included. SARS-CoV-2 RT-PCT on nasopharyngeal swab (NPS) was performed at birth to infants born from mother with acute infection at delivery. A follow-up visit with physical and neurological examination, SARS-CoV-2 RT-PCR on NPS, SARS-CoV-2 serology, and a cranial ultrasound (cUS) was performed within 3 months of life. Automated auditory brainstem response (A-ABR) exams were performed at birth, and auditory steady-state response (ASSR) at six months of life.

Results:

95 infants born from 94 mothers were included. Median gestational age was 39+3 (IQR 38-40) and 10 (10.5%) were preterm. Thirteen (13.7%) newborns required hospital admission after birth, none of them with a COVID-19 infection. Rates of vertical (1/28; 3.6%) and horizontal (1/93; 1.1%) transmitted infections were low, with mild symptoms. In follow-up visit, neurological examination was normal in all infants. Cranial ultrasound was normal in 81/85 (95.3%) infants, with mild abnormalities in four infants. 47/ 95 (50%) infants had a positive serology. Serology result was not related to the severity of the maternal infection, skin-to-skin care at birth or breastfeeding. There was a progressive decrease in SARS-CoV-2 antibody titers with the age (figure 1). No hearing loss was detected.

Conclusions/Learning Points:

In this cohort, most infants born from mothers with SARS-CoV-2 infection during pregnancy had normal cUS, hearing screening and neurological examinations in the follow-up. There is a rapid decrease in transferred maternal antibodies in the first months of life.

Backgrounds:

SARS-CoV-2 variant Omicron (B.1.1.529) is causing the actual wave in Spain, leading to the highest cumulative incidence across the pandemic. It is not known whether this variant causes more severe disease in children.

Methods

Clinical features were collected from children attended at the Emergency Room (ER) at a secondary center in Madrid from December 20^th 2021 to January 2^nd 2022. Charts were reviewed 1 week after diagnosis to check potential complications. Data were compared to children with other variants included in the national COVID-19 database EPICO-AEP. In this comparison, 17 ambulatory patients with Omicron from other center were also included to make data more robust.

Results:

94/1360 children (9.6%) had COVID-19. In 16% of them, variant was identified: 87% Omicron, 13% Delta. Median age was 6.5 years, only 7% were >12 years. Final diagnosis were upper respiratory tract infection (URTI) 61/94 (65%), flu-like syndrome 15/94 (16%), gastroenteritis 7/94 (7%), fever without source (FWS) 3/94 (3%), and migraine or asthma flare 2/94 each (2%). Only 2/94 (2%) patients were hospitalized: a 3-year girl with features of bacterial pneumonia and an Omicron variant; and a 40-days-old infant with whooping-like cough with negative RT-PCR for both Bordetella pertussis and RSV. Hospitalization rate was similar in Omicron and Alpha variant waves (2% vs 4%, p=0.656). Compared to other waves, URTI, headache and fever were more frequent in the Omicron wave, while pneumonia and FWS were in previous waves.

Conclusions/Learning Points:

Children with COVID-19 and Omicron variant seem to have similar profile as other variants, only more fever and URTI and less pneumonia.. Most children were <12 years, which may be related to the high proportion of vaccinated adolescents in our population.

Backgrounds:

Initial antibiotic treatment in appendicitis/peritonitis significantly reduces wound infection and intra-abdominal abscess formation in patients with gangrenous or perforated appendicitis. Randomized controlled trials have shown that the use of lower-spectrum antibiotic combinations is as effective in preventing abscesses or surgical wound infections as broad-spectrum regimens.

Methods

Observational, retrospective study of patients <16 years of age admitted for appendicitis and/or peritonitis from Jan/2014 to Dec/2019 in a tertiary university hospital in Madrid, Spain. Three study periods were established: P1 2014-2015 (before Antimicrobial Stewardship Programme (ASP)), P2 2016-2018 (ASP implemented) and P3 Jan/2019-Dec/2019 (ASP and implementation of an appendicitis/peritonitis protocol with electronic prescription, including lower-spectrum antibiotic combinations and selected and clinically guided use after surgery). Antimicrobial use was analysed with the days of therapy/1000 admissions days (DOT/1000) and start of treatment/1000 hospital admissions (SOT/1000).

Results:

During the study period a total of 1619 patients met inclusion criteria. The proportion of patients without antibiotic therapy after surgery during P1, P2 and P3 was 5.6%, 3.7%, and 38.6% respectively. [C1] The evolution of antibiotic use expressed by DOT / 1000 is shown in Figure 1. SOT/1000 of ampicillin, gentamicin and metronidazole rose from 162, 190 and 190 in 2014 to 386, 402 and 409 in 2019. DOT/1000 of meropenem drop to 64.85 in 2014 to 0 in 2019.

Conclusions/Learning Points:

The implementation of an ASP and a low-spectrum antibiotic protocol with electronic prescribing, reduced the antimicrobial use in children with appendicitis/peritonitis. The proportion of patients without antibiotic therapy after surgery increased and the use of carbapenems and other broad-spectrum antibiotics was reduced after the intervention. These improvements were observed when an electronically available protocol was added to the ASP implementation.

Backgrounds:

Multisystem inflammatory syndrome in children (MIS-C) is a condition characterized by a dysregulated response of the immune system 2-6 weeks after a SARS-CoV-2 infection. Some authors hypothesized that the COVID-19 vaccine could trigger a new exaggerated response in these children.

Our aim was to assess the proportion of vaccinated children and the incidence of new MIS-C or myocarditis after vaccination in adolescents with previous MIS-C.

Methods

From the Epidemiological Study of COVID-19 in Children of the Spanish Pediatric Association, we contacted researchers from centers with ≥3 MIS-C patients aged 12-18 years old by October 31, 2021, hospitalized from March 2020, through October 2021 and fulfilling WHO criteria for MIS-C.

We performed a semi-structured telephonic interview with the caregivers and/or the adolescents, about vaccination acceptance and adverse events after vaccination.

Results:

An interview was possible in 42/48 (87.5%) selected adolescents, being mainly male (30/42, 71.4%) and, at MIS-C diagnosis, their median age was 13.1 years old. 32/42 (76.2%) patients had received COVID-19 vaccine. The median time between MIS-C diagnosis and vaccination was 42 weeks and the telephonic interview took place after a median of 10.0 weeks (range 5.3-19.7) post-vaccination. After vaccination, 22/32 (68.8%) patients reported adverse events, being 86.7% mild and 3.3% moderate (Table1). No new MIS-C or myocarditis or pericarditis episodes were reported.

Conclusions/Learning Points:

In this study, we describe a high acceptance and low incidence of relevant adverse events after COVID-19 vaccines in a population of adolescents with a previous MIS-C diagnosis. No new MIS-C episodes or myocarditis occurred after a median of 10 weeks post-vaccination. The results of this study are reassuring and may help to decide for patients with previous MIS-C who are considering COVID-19 vaccination.

Backgrounds:

Gram-negative bacteremia (GNB) is associated with a significant rate of morbidity and mortality in adults. Moreover, resistances to antibiotics are increasingly described in surveillance reports. However, the epidemiology and outcomes of GNB in children are not well known. We aimed to analyze GNB bacteremia in pediatric patients in a tertiary hospital over a three years period.

Methods

A retrospective, observational study of bacteremia episodes caused by Enterobacteriaceae or non-fermentative GNB in pediatric patients between January of 2018 and December 2020 in a Tertiary Hospital from Madrid, Spain, was carried out through microbiology charts and clinical records. Demography, comorbidities, risk factors and infection characteristics were recorded, and bacterial strain and antibiotic resistance were registered. Three primary endpoints were defined: mortality, bacteremia persistence and recurrence. A statistical analysis was applied to assess differences in these outcomes according to the risk factors. A multivariable logistic regression analysis was used to assess the association between bacteria resistance and mortality.

Results:

One hundred eighteen cases of GNB in one hundred and seven patients were included. The characteristics of the patients are shown in Table 1. In fifty-three cases (44.9%) GNB presented resistance to at least one group of antibiotic and in nine (7.6%) were multidrug-resistant (Table 1). The incidence of resistance rates by years were stable. Indwelling urinary catheterization was a risk factor associated to mortality [OR 3.48 (1.20-10.6)] and parenteral nutrition was related to persistent bacteremia [OR 7.69 (1.1-209)]. No relation between drug resistance and mortality was observed in multivariable analysis.

Conclusions/Learning Points:

GNB represented an important problem in our institution, mainly related to neonatal intensive care and heart surgery. Antibiotic resistance was common. Patients that carried invasive care devices presented higher rates of bacteremia persistence and mortality.

Backgrounds:

Multisystem inflammatory syndrome in children (MIS-C) is a condition characterized by a dysregulated response of the immune system 2-6 weeks after a SARS-CoV-2 infection. Some authors hypothesized that the COVID-19 vaccine could trigger a new exaggerated response in these children.

Our aim was to assess the proportion of vaccinated children and the incidence of new MIS-C or myocarditis after vaccination in adolescents with previous MIS-C.

Methods

From the Epidemiological Study of COVID-19 in Children of the Spanish Pediatric Association, we contacted researchers from centers with ≥3 MIS-C patients aged 12-18 years old by October 31, 2021, hospitalized from March 2020, through October 2021 and fulfilling WHO criteria for MIS-C.

We performed a semi-structured telephonic interview with the caregivers and/or the adolescents, about vaccination acceptance and adverse events after vaccination.

Results:

An interview was possible in 42/48 (87.5%) selected adolescents, being mainly male (30/42, 71.4%) and, at MIS-C diagnosis, their median age was 13.1 years old. 32/42 (76.2%) patients had received COVID-19 vaccine. The median time between MIS-C diagnosis and vaccination was 42 weeks and the telephonic interview took place after a median of 10.0 weeks (range 5.3-19.7) post-vaccination. After vaccination, 22/32 (68.8%) patients reported adverse events, being 86.7% mild and 3.3% moderate (Table1). No new MIS-C or myocarditis or pericarditis episodes were reported.

Conclusions/Learning Points:

In this study, we describe a high acceptance and low incidence of relevant adverse events after COVID-19 vaccines in a population of adolescents with a previous MIS-C diagnosis. No new MIS-C episodes or myocarditis occurred after a median of 10 weeks post-vaccination. The results of this study are reassuring and may help to decide for patients with previous MIS-C who are considering COVID-19 vaccination.