Welcome to the WSPID 2022 Virtual Congress Calendar

Background

Since the appearance of the coronavirus disease 2019 (COVID-19), clinical characteristics have been described in adults and children, however, there is limited information on the impact of maternal infection on newborns.

Aims

To describe the clinical characteristics and outcomes of newborns following COVID-19 in pregnancy.

Methods

A retrospective, multicenter cohort study from March 11, 2020 to March 1, 2021, comparing clinical characteristics and outcomes of newborns born to mothers with and without COVID-19 during pregnancy, and the SARS-CoV-2-positivity rate of neonates with SARS-CoV-2-positive mother. Data included maternal and neonatal symptoms such as gestational age, birth weight, neonatal and maternal symptoms, antenatal complications, length of hospital stay, neonatal intensive care unit admission, mechanical ventilation, and death. For the comparison of continuous variables and dichotomous variables, the Mann-Whitney U test and Fisher's exact test were used.

Results

Of 177 neonates, 73 were born to SARS-CoV-2-positive mothers. 75.3% of positive pregnant women were asymptomatic, with no severe cases reported. In neonates born to SARS-CoV-2-positive mothers, we found an increased prevalence of prematurity [12 (16.4%) vs 7 (6.7%), p=0.05], neonatal respiratory symptoms [8 (11%) vs 1 (0.9%), p=0.004] and need for mechanical ventilation [7 (9.6%) vs 1 (1%), p=0.009]. No neonatal deaths were reported. SARS-CoV-2-positivity-rate was 6.8% in neonates at 24-hours.

Conclusions

These data suggest that newborns of mothers with COVID-19 are at increased risk of complications in the neonatal period, however, the prognosis appears to be favorable as no deaths were reported. Considering the high prevalence of asymptomatic COVID-19 among pregnant women, it is essential to implement effective screening.

Background

MIS-C is an inflammatory condition following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Aims

To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes

Methods

This comparative cross-sectional study was
done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma.

Results

During study 34 cases of MIS-C and 83 cases of Dengue fever were
enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 (44%), MIS-C without shock, 17 (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C.
Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean
hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days; P=0.014)

Conclusions

Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.

Background

Distinguishing children with SARS-CoV-2 infection compared to other acute respiratory illnesses (ARIs) would assist treatment and infection control strategies, especially where resources are limited.

Aims

The study aim was to describe the profile and outcomes of SA children with ARI with and without SARS-CoV-2 infection.

Methods

In this cross-sectional study, we evaluated routinely collected clinical data of children 0-13 years presenting with ARIs to Tygerberg Hospital, Cape Town between May 2020- November 2020. SARS-CoV-2 PCR was performed on all admitted children presenting with respiratory symptoms.

Results

Data of 178 children was included. SARS-CoV-2 positive children (40/178, 22.5%) were younger (median 6.7 vs 17 months, p=0.09), had lower weight-for-age Z-score (-0.83 vs -0.54, p=0.02) and were more likely female (55% vs 38%, p<0.01). Underlying comorbidities were similar in both groups. Multivariable logistic regression analysis showed SARS-CoV-2 positive children more frequently presented with fever (OR 3.9, 95CI 1.7-8.8), and were less likely to have cough (OR 0.3 95CI 0.1-0.6).

Oxygen supplementation (73% vs 75%, p=0.79) and respiratory support (38% vs 26%, p=0.16) were similar between groups, but SARS-CoV-2 positive children were more likely to require PICU (18% vs 7%, p=0.03) and remain on oxygen (median 6 vs 2 days, p=0.01). Readmission within 3 months for respiratory reason was similar (18% vs 15%, p=0.64).

Conclusions

Clinical presentation between children with and without SARS-CoV-2 was comparable. Children with SARS-CoV-2 infection required longer oxygen supplementation and more PICU admissions. These findings suggest a potentially differential long-term outcome in children with SARS-CoV-2 which requires further investigation.

Background

Children and adolescents with SARS-CoV-2 infection (COVID-19) are less likely to have severe pneumonia but may present with multisystem inflammatory syndrome (MIS-C) and both these conditions have low mortality. There are limited data on the characteristics and outcomes of children with severe COVID-19 and MIS-C requiring paediatric intensive care (PICU) from resource-limited settings.

Aims

We aim to describe the indications for admission and the outcomes of patients admitted to PICU at Tygerberg Hospital in Cape Town, South Africa.

Methods

Retrospective review of patients < 13 years admitted to PICU with COVID-19 or MIS-C from 17 April 2020 to 31 August 2021.

Results

Sixty three patients required PICU. Twenty-three (36.5%) had MIS-C, 35 (55.5%) had severe COVID-19 and in five (7.9%) children the COVID-19 was thought to be incidental. Patients with MIS-C were older (median age 84 months, IQR 48.0-108.0) than those admitted with severe COVID 19 (median age 20.5 months, IQR 7.0-57.5). Co-morbid disease was more common in children with severe COVID-19 (18/35, 51.4%), than in children with MIS-C (4/23, 17,4%). No children with MIS-C died, but 10 out of 35 children with severe COVID-19 died (28.6%). Of the children admitted to PICU with severe COVID-19 23/35 (63.8%) required invasive ventilation and 15/35 (35.7%) inotropic support. More children with MISC required inotropic support (15/23, 65%).

Conclusions

This cohort is small, but we are concerned that in this group of children with COVID-19 mortality is high once admission to PICU is required. Children with MIS-C had good outcomes.

Background

SARS-CoV-2 infection became a public health emergency around the world. Although infection in adults has been described as more severe when compared with children, the real burden of disease in vulnerable population such as neonates is still not well understood.

Aims

We sought to describe the clinical characteristics of patients younger than 90 days of age infected with SARS-CoV-2 in the only tertiary hospital in Costa Rica.

Methods

We collected the clinical information of patients diagnosed with Covid-19 using PCR between August 2020 to July 2021. After discharge, patients were contacted once by phone for follow-up. Clinical presentation, laboratory findings, and outcomes were analyzed for this report.

Results

Between August 2020-July 2021, 72 patients younger than 90 days of age were included. Median age was 36 days [24.5-56.8], with most patients having adequate prenatal care (86%), complete vaccination schedules, (97%), and being breastfed (97%). Fever (58%), rhinorrhea (43%), increase work of breathing (40%), and cough (38%) were the most common clinical findings at admission. Most patients were admitted (79%), with 33 (46%) requiring oxygen and 8 (11%) needing PICU admission. Outpatients were older (54 [48-60] vs. 32 [24-51] days of age, p=0.027), and presented most commonly with rhinorrhea (80% vs. 33%, p=0.002) and lower lymphocytes counts (2.1 [1.8-3] vs. 4.1 [2.5-6], p=0.04). No patients died during the study period.

Conclusions

SARS-CoV-2 infection in young infants is still not well understood, and clinical presentation varies among this population. Understanding the clinical presentation could help us predict possible outcomes in this vulnerable group.

Background

Inflammatory markers (IM) are measured commonly in febrile children. Their use has increased during the COVID-19 pandemic due to the risk of multisystem inflammatory syndrome (MIS-C). Little is known about changes in IM during acute Covid-19 infection, MIS-C, or other viral syndromes.

Aims

Compare IM levels in children with acute viral syndromes (AVS), COVID-19 and MIS-C.

Methods

We reviewed charts of 40 children admitted to JHS during July-August 2021 with fever. Tests were performed per standard protocol for evaluation of pediatric patients with fever and suspected MIS-C. Hospital course, treatments and discharge diagnoses were noted. Patients were grouped together as: testing positive for a virus other than SARS CoV-2 (AVS), positive SARS CoV-2 PCR (COVID-19), and if met CDC criteria for MIS-C and improved after anti-inflammatory treatment (MIS-C). Values are mean ± standard deviation and T-test.

Results

There were 26 males and 14 females. 17 children were diagnosed with AVS, 17 with COVID-19, and 6 with MIS-C. IM levels are shown in the table. There were no statistical differences between diagnostic groups of any IM.

Inflammatory markers in children with fever according to established diagnosis

Conclusions

1. Our preliminary data suggest routine IM screening cannot distinguish between AVS, Covid-19, and MIS-C.

2. MIS-C was characterized by a higher NT-proBNP, while ferritin was highest among children with AVS.

3. Further research is needed with more patients to better understand IM changes in febrile children.