Pediatric Infectious Disease Journal

ObjectiveThis scoping review aims to assess the evidence regarding miRNA associations with paediatric bacterial and viral infections. IntroductionFebrile children present a challenge in emergency care, often leading to unnecessary antibiotics due to difficulty distinguishing bacterial from viral infections. Current biomarkers lack specificity, contributing to diagnostic uncertainty and antimicrobial resistance. MicroRNAs (miRNAs), detectable in blood and responsive to disease, show promise as improved biomarkers, but their role in infection differentiation remains unclear. This scoping review aims to map known miRNA associations with paediatric infections and evaluates study methodologies to identify the best approaches for miRNA-based diagnostics. Inclusion criteriaStudies reporting on children under 18 years of age with acute bacterial or viral infections will be included. Articles must focus on host miRNA biomarkers in biofluids. Exclusions include chronic infections, parasitic infections, fungal infections, sexually transmitted infections, animal models, in vitro, tissue samples, and in silico studies. MethodsThe databases to be searched will include MEDLINE and Web of Science with an additional for grey literature search via Google, Google Scholar, and open Theses restricted to the English language. Titles and abstracts will be screened, and eligible articles will undergo full-text review. The results of the search and study inclusion/exclusion process will be reported. Reasons for exclusion during the full text review are presented in the PRISMA-ScR flow diagram. Data will be extracted into a chart, analysed as percentages to assess consensus, and summarized in descriptive text with tables.

COVID-19 disease can give a range of skin manifestations, some of which specific to children and young patients. Given the different nature of the lesions in specific stages of the disease and the fact that they may be the only or predominant symptom of the disease, it is of great importance for the pediatrician and dermatologist to be familiar with COVID-19 skin lesions. The aim of this systematic review, conducted according to the PRISMA statement, is to investigate COVID-19-associated cutaneous involvement in children in terms of type of skin lesions, frequency, and time of onset, with the exclusion of those associated with multisystem inflammatory syndrome in children. A comprehensive literature search will be performed through PubMed between December 2019 and December 2021. The quality of each study will be assessed according to the STROBE tool for observational studies. This systematic review will provide evidence about the dermatological manifestations of COVID-19 disease in children published up to the end of year 2021. Recognizing skin symptoms as potential manifestations of COVID-19 in children is important for a non-delayed diagnosis, with prompt activation of the adequate tracing, isolation, and hygienic measures, and for timely treatment of unlikely but possible serious complications.

BackgroundDespite the growing literature on multisystem inflammatory syndrome in children (MIS-C), the data in European White population is limited. Our aim was to capture MIS-C emergence in Poland (central Europe) and to describe its characteristics with a focus on severity determinants. MethodsPatients who met the MIS-C definition (fever, multiorgan failure, inflammation, and proven SARS-CoV-2 infection or contact) were reported retrospectively and prospectively in an online survey. Study definitions fulfilment was automatically evaluated by a dedicated software. For the assessment of univariate relationships, either directed or divided by sex, age, or disease severity, we used the test for two categorical variables and the Kruskal-Wallis test for categorical-continuous variable pairs. FindingsThe analysis involved 274 children, 62.8% boys, median age 8.8 years. Besides one Asian, all were European White. Merely 23 (8.4%) required paediatric intensive care treatment (PICU). They were older (11.2 vs. 8.4 years), and at hospital admission had higher respiratory rate (30 v. 20/minute), lower systolic blood pressure (89 vs. 100 mmHg), prolonged capillary refill time (40% vs. 11%), and decreased consciousness (22% vs. 5%). Teenage boys had more common cardiac involvement (fraction 25.9% vs. 14.7%) and macrophage activation syndrome (31.0% vs. 15.2%) than others. Boys were also more often hospitalised in PICU with age (from median 11.2 years to 9.1). InterpretationThe severity of MIS-C is not as uniform as it seemed, ethnicity and sex may affect MIS-C phenotype. Management might not be universally applicable and should rather be adjusted to the specific population. FundingPSP: 501-D402-20-0006100

BackgroundWith the rise of the COVID-19 pandemic, a new severe life-threatening inflammatory syndrome has been reported in some pediatric populations. Global attention was shifted towards the syndrome termed multisystem inflammatory syndrome in children (MIS-C), with new case reports flooding in. ObjectivesThe aim of this scoping review is to summarize the existing reports on MIS-C and focus on the demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes. MethodsWe conducted a systemic search using LitCovid and MEDLINE electronic databases. We screened citations, titles and abstracts, then reviewed potentially relevant articles in full. After data extraction, we reported our final data under subheadings of demographics, diagnosis, clinical presentation, laboratory investigations, imaging studies, treatment, and patient outcomes. ResultsOur search strategy yielded 42 original studies reporting 674 pediatric patients fitting the case definition of MIS-C. The studies included 21 case reports, 16 case series and 5 cohort studies. The most common reported symptom of MIS-C was fever (98%). Gastrointestinal symptoms were common (N=557, 83%). Interleukin-6 (IL-6) levels were measured in 125 patients and was elevated in 94 % (N=117). Echocardiography detected coronary artery lesions in 100 patients. Prophylactic and/or therapeutic heparin was required in 34% (N=227) of patients. The most commonly administered treatment modality targeting MIS-C was intravenous immunoglobulin (IVIG) (N=490). Corticosteroids (N=347) and aspirin (N=112) were also integral parts of the treatment regimens. Biologic therapy was integrated into the treatment regimen for 116 patients. Intensive care unit (ICU) admission was alarming (N=478, 71%). 9 fatalities were recorded due to MIS-C ConclusionsWe believe MIS-C bears pathophysiological resemblance to the well-known Kawasaki disease but with some key differences highlighted. Understanding those differences will aid our management plan for such patients.

BackgroundMycoplasma pneumoniae pneumonia (MPP), often referred to as walking pneumonia, is a common cause of community-acquired pneumonia (CAP) in children and presents with a broad clinical spectrum. While many cases are mild and self-limiting, a subset progresses to severe disease marked by hyperinflammation and systemic complications. This clinical variability presents challenges in early diagnosis and risk stratification. This study aimed to identify prognostic markers associated with MPP severity and explore potential underlying inflammatory mechanisms. MethodsA total of 170 pediatric patients (1-14 years) were enrolled, including 120 MPP cases and 50 non-MPP controls. Serum levels of P2X7, NLRP3, IL-1{beta}, and IL-18 were measured by ELISA. Routine laboratory markers (CRP, LDH, D-dimer, and IgE) were evaluated for their association with severe MPP (sMPP). Pathway enrichment and STRING network analyses were performed to contextualize the clinical markers within inflammation-related molecular pathways. ROC curve analysis was used to assess the predictive value of individual biomarkers. ResultsMultivariate logistic regression identified CRP, LDH, D-dimer, and IgE as independent risk factors for sMPP (p<0.05). Pathway enrichment revealed these markers to be involved in acute-phase response, coagulation, cytokine signaling, and immune regulation. STRING network analysis further demonstrated their convergence on the NLRP3 inflammasome axis. Serum levels of P2X7, NLRP3, IL-1{beta}, and IL-18 were significantly elevated in sMPP cases compared to non-severe MPP and controls (p<0.001). ROC analysis showed all four had strong predictive performance (AUC > 0.7, p<0.001). ConclusionThis study confirms that elevated levels of CRP, LDH, D-dimer, and IgE are independently associated with severe Mycoplasma pneumoniae pneumonia (sMPP), reflecting systemic inflammation, tissue injury, and immune dysregulation. Importantly, the concurrent upregulation of P2X7, NLRP3, IL-1{beta}, and IL-18 in serum, supported by pathway enrichment and STRING network analyses, highlights a central role for inflammasome activation in sMPP pathogenesis. ROC curve analysis further demonstrated the strong predictive value of these inflammasome-related proteins. Collectively, these findings suggest that P2X7, NLRP3, IL-1{beta}, and IL-18, in combination with conventional markers such as CRP, LDH, D-dimer, and IgE, may serve as valuable biomarkers for the early identification and risk stratification of children at risk for severe MPP, thereby enhancing diagnostic precision and informing clinical decision-making.

BackgroundSymptoms of SARS-CoV-2 infection in children are nonspecific and shared with other common acute viral illnesses (fever, respiratory or gastrointestinal symptoms, and cutaneous signs), thus making clinical differential diagnosis tricky. In Italy, first line management of pediatric care is handed over to Primary Care Pediatricians (PCPs), who were not allowed to directly perform diagnostic tests during the recent COVID-19 outbreak. Without a confirmatory diagnosis, PCPs could only collect information on "COVID-19 like symptoms" rather than identify typical COVID-19 symptoms. AimTo evaluate the prevalence of COVID-19 like symptoms in outpatient children, during Italian lockdown. To provide PCPs a risk score to be used in clinical practice during the differential diagnosis process. MethodsA survey was submitted to 50 PCPs (assisting 47,500 children) from 7 different Italian regions between the 4th of March and the 23rd of May 2020 (total and partial lockdown period). COVID-19 like symptoms in the assisted children were recorded, as well as presence of confirmed/suspected cases in childrens families, which was taken as proxy of COVID-19. Multivariable logistic regression was accomplished to estimate the risk of having suspected/confirmed cases in families, considering symptoms as potential determinants. Results2,300 children (4.8% of overall survey population) fell ill with COVID-19 like symptoms, 3.1% and 1.7% during total and partial lockdown period respectively. The concurrent presence of fatigue, cough, and diarrhea in children, in absence of sore throat/earache and abnormal skin signs, represents the maximum risk level of having a suspected/confirmed case of COVID-19 at home. ConclusionsThe percentage of children presenting COVID-19 like symptoms at home has been remarkable also during the total lockdown period. The present study identified a pattern of symptoms which could help, in a cost-effective perspective, PCPs in daily clinical practice to define priorities in addressing children to the proper diagnostic procedure.

BackgroundThere is growing evidence of Multisystem Inflammatory Syndrome in Children (MIS-C) resembling Kawasaki disease in children infected with SARS-CoV-2. The review was undertaken to evaluate the case definition, the spectrum of clinical presentations and current management practices in children with COVID-19 presenting with or without MIS-C. MethodsThe individual patient data from 119 studies accounting for 333 children were analyzed. We devised a scoring system as per WHO criteria to classify the patients as MIS-C or without MIS-C. A score of 3 was given for the presence of fever (>24h) and a score of 1 for lab-confirmed diagnosis of SARS-CoV-2. Additionally, a score of 1 was given for a) rash or conjunctivitis or muco-cutaneous inflammation signs, b) hypotension or shock, c) diarrhea, vomiting or abdominal pain, d) features of myocardial dysfunction as determined by abnormal eco-cardiography or elevated Troponin or N-terminal pro B-type Natriuretic Peptide (NT-proBNP), e) evidence of coagulopathy as evidenced by elevated levels of prothrombin time PT, partial thromboplastin time PTT or D-dimer, f) laboratory evidence of inflammation as determined by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) or procalcitonin. A negative score of (-3) was given when there was a diagnosis of sepsis, staphylococcal or streptococcal shock syndrome. Based on these criteria, a minimum score of 6 was essential to classify the child as MIS-C. ResultsBased on this score, 18% (52/289) of cases were identified to be MIS-C. A greater proportion of children with MIS-C had cardiac involvement (MIS-C 80% vs Non-MIS-C 20%) and gastrointestinal involvement (MIS-C 71% vs Non-MIS-C 12%). Lymphopenia was commonly reported in MIS-C (MIS-C 54.2% vs Non-MIS-C 29.7%). In addition to routine inflammatory markers, significantly greater proportion of children with MIS-C had elevated Ferritin, LDH, Fibrinogen and IL-6. Children with MIS-C were less likely to have respiratory symptoms like cough (MIS-C 25% vs Non-MIS-C 75%) and rhinorrhea (MIS-C 4% vs Non-MIS-C 22.8%). A greater proportion of children with MIS-C required intensive care and aggressive treatment; and mortality rates were also higher in MIS-C group (MIS-C 10% vs Non-MIS-C 1%). ConclusionThe children with COVID-19 having cardiac and/or gastrointestinal involvement are more likely to develop MIS-C. The children with MIS-C have higher mortality rates. The scoring system developed herein will aid clinicians in patient diagnosis and timely management.

IntroductionCOVID 19 is still a challenge in pediatrics due to variety of symptoms and different presentations AimTo describe clinical, laboratorial and treatment of confirmed COVID-19 pediatric admitted in hospitals. MethodsA retrospective study was conducted in children (0-18 years), admitted between March and November 15, 2020, with confirmed COVID-19 by reverse transcription polymerase chain reaction or serological tests. Clinical data about symptoms, laboratorial exams and treatments were analysed. Patients were evaluated according predominant (PRS) or non-predominant respiratory symptoms (non-PRS) ResultsSixty-four patients were evaluated, being the median age 5.6 years. Forty-seven (73.4%) children were admitted with PRS and 17 (26.4%) with non-PRS. The main symptoms in the PRS group were fever in 74.5% of children and cough in 66%; and fever in 76.5% and edema/cavitary effusion in 29.4% in the non-PRS group. The median of C-reactive protein (in mg/dl) was 2.5 in the PRS group and 6.1 in the non-PRS group. Antibiotics were used in 85.1% of the PRS group and 94.1% of non-group. Comorbidity was present in 30/47 (63.8%) of PRS group and 8/17 (47.1%) of non-PRS group (p=0.22). Length of stay until 7 days in patients with comorbidity was present in 27/64 (42.1%) and more than 7 days in 11/64 (17.1%) (p= 0.2) ConclusionNon-PRS represented more than one quarter of admitted patients. Fever was the main symptom detected, elevated CRP was frequent and antibiotics were commonly prescribed. Comorbidity was found in both groups and his presence was not associated with a longer length of stay.

Respiratory exacerbations are a frequent cause of hospitalisation in children with severe neurodisability (ND). Direct aspiration of food/saliva, reflux aspiration of gastric contents or a combination of both is thought to be a common cause of respiratory symptoms and disease, particularly when this occurs silently. A number of aspiration biomarkers, including bile acids and pepsin, have been proposed, however, no gold-standard diagnostic tests are currently available. In children with severe ND at high risk of both direct and reflux aspiration, we analysed lower airway samples for saliva- and/or gastric-specific proteins with biomarker potential.

Using electronic health record data combined with primary chart review, we identified 7 children across 8 pediatric medical centers with a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) who were managed as outpatients. These findings should prompt a discussion about modifying the case definition to allow for such a possibility.

ObjectiveFaced with the SARS-CoV-2 epidemic, the real impact of the disease on children and adolescents and the behavior of the disease in this population are questioned. This study aims to assess the clinical characteristics of children and adolescents with SARS-CoV-2 infection and the effectiveness of the measures adopted at the institution. MethodsThis is a prospective study carried out from 11/04/2020 to 19/06/2020. Investigated 346 patients between zero and eighteen years old, with analysis of patients diagnosed with COVID-19 confirmed by RT-PCR, obtained from a nasopharynx and oropharynx swab, attended at a highly complex public pediatric hospital in the city of Sao Paulo. Protocols for clinical management and treatment of cases of SARS-CoV-2 infection were adopted during the assistance and implementation of a preoperative screening protocol. They were evaluated according to sex, age, epidemiology, presence of comorbidities, clinical manifestations, therapy used, need for hospitalization in the ward and ICU, use of mechanical ventilation (MV) and evolution. Results66 confirmed patients with COVID 19 were identified. Median age was 7 years old, with the male gender predominant (2:1). 27 patients (40.9%) had contact with symptomatic respiratory individuals, comorbidity occurred in 50 cases (75.8%). Main clinical manifestations were: fever, 37 patients (56.1%); cough, 23 (34.8%); respiratory distress in 10 (15.2%) and gastrointestinal symptoms in 24 (36.4%). 38 patients (57.6%) received antibiotics and 13 (19.7%) received corticotherapy. 37 patients (56.1%) required hospitalization, eight (19.5%) in the ICU and six (75%) requiring MV. One death occurred and others with good evolution. ConclusionThis study corroborates the perception that the pediatric patient has a more benign manifestation, even in the presence of comorbidities, requiring the screening of surgical patients. The protocol adopted by the institution proved to be effective, with no contamination being observed among patients or between patients and collaborators.

BACKGROUNDEstimates of pediatric morbidity and mortality from COVID-19 are vital for planning optimal use of human and material resources throughout this pandemic. METHODSGovernment websites from countries with minimum 1000 cases in adults and children on April 13, 2020 were searched to find the number of cases confirmed in children, the age range, and the number leading to hospitalization, intensive care unit (ICU) admission or death. A systematic literature search was performed April 13, 2020 to find additional data from cases series. RESULTSData on pediatric cases were available from government websites for 23 of the 70 countries with minimum 1000 cases by April 13, 2020. Of 424 978 cases in these 23 countries, 8113 (1.9%) occurred in children. Nine publications provided data from 4251 cases in 4 additional countries. Combining data from the websites and the publications, 330 of 2361 cases required admission (14%). The ICU admission rate was 2.2 % of confirmed cases (44 of 2031) and 7.2% of admitted children (23 of 318). Death was reported for 15 cases. CONCLUSIONChildren accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold for testing) with about 7% of admitted children requiring ICU care. Death is rare in middle and high income countries.

BackgroundThe COVID-19 pandemic affected Respiratory Syncytial Virus (RSV) circulation and surveillance, causing logistical complexity for health systems. Our objective was to describe changes in epidemiology and clinical severity of RSV cases in British Columbia, Canada. MethodsComparative analysis of RSV detections in children <36 months at BC Childrens Hospital (BCCH) between September 1 and August 31 of 2017-18, 2018-19, 2019-20, 2020-21 and 2021-22. ResultsAbout one-fifth of children tested RSV positive on average across all periods. The median age of RSV cases was 11.8 [IQR: 3.8-22.3] months in 2021-22 versus 6.3 [IQR: 1.9-16.7] months in 2017-20 (p<0.001). Increased testing in 2021-22 (n=3,120) compared to 2017-20 (average n=1,222/period) detected milder infections with lower proportion hospitalized in all age subgroups <6 (26.0%), 6-11 (12.3%), 12-23 (12.2%) and 24-35 (16.0%) months versus 2017-20 (49.3%, 53.5%, 62.6%, 57.5%, respectively) (all p<0.001). Children <6 months consistently comprised most hospitalizations and those born prematurely <29 weeks or with chronic respiratory co-morbidities remained at highest hospitalization risk in 2021-22. Among hospitalized cases, intensive care, respiratory support or supplemental oxygen use did not differ between the 2017-20 and 2021-22 periods. ConclusionsRSV circulation halted during the pandemic, but with the lifting of mitigation measures a subsequent resurgence in children <36 months of age was accompanied by shift toward older (24-35 month) cases in 2021-22, without increased severity. For the 2022-23 period, increased circulation and residual vulnerability in additional birth cohorts spared from RSV infection during the pandemic could have marked cumulative healthcare impact, even without increase in proportion hospitalized.

BackgroundIn late 2022, a surge of severe bacterial infections caused by S. pyogenes was reported in several European countries, including Germany. This study assessed disease burden and severity of hospitalizations for community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. MethodsHospital cases due to bacterial infections between October and December 2022 were collected from 59/62 (95 %) childrens hospitals in NRW and combined with surveillance data (2016 - 2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Total cases in NRW and incidence rates from January 2016 to March 2023 were estimated by capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. ResultsBetween October and December 2022, 153 cases with high overall disease severity were reported with pneumonia being most common (59 %, n = 91). Incidence rates of bacterial infections declined at the beginning of the COVID-19 pandemic. In late 2022 and early 2023 a massive surge to levels unprecedented since 2016 was observed, mainly driven by S. pyogenes and S. pneumoniae. Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). DiscussionThe unprecedented peak of bacterial infections in late 2022 and early 2023 was caused by various mechanisms intertwined that require close surveillance and improved precautionary measures for future outbreaks.

There is increasing reporting by patients organization and researchers of long covid (or post-acute sequelae of SARS-CoV-2 - PASC), characterized by symptoms such as fatigue, dyspnea, chest pain, cognitive and sleeping disturbances, arthralgia and decline in quality of life. Immune system dysregulation with a hyperinflammatory state, direct viral toxicity, endothelial damage and microvascular injury have been proposed as pathologenic mechanisms. Recently, cohorts of children with PASC have been reported in Italy, Sweden and Russia. However, immunological studies of children with PASC have never been performed. In this study, we documented significant immunologic differences between children that completely recovered from acute infection and those with PASC, providing the first objective laboratory sign of the existence of PASC in children.

AimTo map and synthesise the evidence on the scattered and heterogeneous reported prevalence of Bacillus Calmette-Guerin scar reactivation (BCGitis) in Kawasaki disease (KD), examine clinical associations, and identify knowledge gaps for future research. MethodsA scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library were searched for observational studies of BCG-vaccinated children with KD. We retrieved the prevalence of BCGitis and its associations with age, sex, KD form, BCG vaccine strain, coronary artery abnormalities (CAA), and treatment response. ResultsFifteen studies from five Asian countries (Japan, Korea, Taiwan, China, Singapore), including 21,880 children with KD, were identified. The reported prevalence of BCGitis ranged from 3.5% to 75.2% (overall prevalence 40.1%, 95% CI 39.6-40.6), with a higher prevalence in younger children. It was associated with lower CAA rates (11.8% vs 13.8%) but showed no significant association with KD type, vaccine strain, or treatment response. ConclusionBCGitis is a common manifestation of KD in BCG-vaccinated children and may have diagnostic and prognostic value, particularly in younger children and those with incomplete presentations.

Data from adult studies how that COVID-19 is more severe in men than women. However, no data are available for the pediatric population. For this reason, we performed this study aiming to understand if sex influenced disease severity and outcomes in a large cohort of latin-american children with COVID-19 and Multisystem Inflammatory Syndrome (MIS-C). We found that a higher percentage of male children developed MIS-C (8.9% vs 5% in females) and died (1.2% and 0.4% in females), although on multivariate adjusted analyses the only statistically significant difference was found in need of hospitalization, with females less frequently admitted compared with boys (25.6% vs 35.4%). This data are preliminary and need further independent studies to better assess the role of sex.

Objective: To describe the clinical characteristics of term neonates with neonatal bacterial meningitis (NBM) and explore the association between different pathogens and imaging complications, providing clinical evidence for early identification and individualized management. Methods: A retrospective study was conducted on 531 term neonates diagnosed with NBM admitted to the Capital Institute of Pediatrics from 2013 to 2025. Demographics, clinical manifestations, laboratory parameters, etiological results, imaging complications and treatment measures were collected. Patients were divided into favorable/adverse discharge outcome groups and pathogen-positive/negative groups. Statistical analyses were performed using appropriate tests, and Cramers V coefficient was used to analyze the association between pathogens and imaging complications. Results: (1) The most common clinical manifestations were abnormal body temperature (79.85%), altered consciousness (55.18%) and jaundice (46.52%). CSF/blood culture was positive in 133 cases (25.05%), with Escherichia coli (27.07%), group B streptococcus (17.29%) and Staphylococcus species (16.54%) as predominant pathogens. The overall incidence of imaging complications was 22.22%, mainly hydrocephalus (5.84%), subdural effusion (4.90%) and encephalomalacia (2.64%). (2) Adverse discharge outcomes occurred in 107 cases (20.15%). Compared with the favorable group, the adverse group had higher incidences of convulsions, altered consciousness, anterior fontanelle bulging, abnormal muscle tone and primitive reflexes (all P<0.001), more obvious laboratory abnormalities (higher CRP, CSF leukocytes and protein, lower CSF glucose, all P<0.05), higher culture positive rates and greater need for adjuvant therapy (all P<0.001). (3) Pathogen-positive patients had higher imaging complication rates. Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates, while Gram-positive infections had higher brain abscess risk. Specifically, Escherichia coli correlated with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; LM with intracranial hemorrhage and brain abscess; negative cultures correlated with no imaging complications (all P<0.05). Conclusion: Term NBM neonates have non-specific manifestations, mainly abnormal body temperature and altered consciousness. Predominant pathogens are Escherichia coli, group B streptococcus and Staphylococcus species, with hydrocephalus and subdural effusion as common imaging complications. Adverse outcomes are associated with severe symptoms, obvious laboratory abnormalities and higher pathogen positivity. Specific pathogens correlate with distinct imaging complications.

Reducing procedural discomfort for children requiring respiratory testing for SARS-CoV-2 is important in supporting testing strategies for case identification. Alternative sampling methods to nose and throat swabs, which can be self-collected, may reduce laboratory-based testing requirements and provide rapid results for clearance to attend school or hospital settings. The aim of this study was to compare preference and diagnostic sensitivity of a novel anterior nasal swab (ANS), and saliva, with a standard combined nose and throat (CTN) swab. The three samples were self-collected by children aged 5-18 years who had COVID-19 or were a household close contact. Samples were analysed by reverse transcription polymerase chain reaction (RT-PCR) on the Allplex SARS-CoV-2 Assay. Most children and parents preferred the ANS and saliva swab over the CTN swab for future testing. The ANS was highly sensitive (sensitivity 1.000 (95% Confidence Interval (CI) 0.920, 1.000)) for SARS-CoV-2 detection, compared to saliva (sensitivity 0.886, 95% CI 0.754, 0.962). We conclude the novel ANS is a highly sensitive and more comfortable method for SARS-CoV-2 detection when compared to CTN swab.

BackgroundStrong social distancing measures were quickly implemented in Chile during the SARS-CoV-2 outbreak. One of the aims of non-pharmaceutical interventions (NPI) mandates was to decrease overcrowding, thus is usually measured as mobility changes. Methodswe gather data from national health statistics for pediatric emergency (PED) visits for acute respiratory infection (ARI) in children younger than 15. We defined a historical cohort, including data from 2016 to 2019, and compared them with 2020 and 2021 pandemic years. Also, Chiles national mobility reports from the online google database were downloaded. We tested the correlation between changes in mobility and relative reduction in PED-ARI by Spearmans Rank Test. ResultsHistorical data showed a mean of 46863 {+/-} 3071 PED-ARI weekly visits with a high seasonal variation, with two peaks in weeks 20 and 28 and weeks 32 to 36. This transient drop was temporally associated with the mid-winter 2-week holiday of schools. The usual PED visits peaks did not occur in 2020 and 2021. Mobility declined from week 9, reaching lower than historical data from week 12 and a minimum of 43% in week 15 of 2020 (Figure 1). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/22276017v1_fig1.gif" ALT="Figure 1"> View larger version (19K): org.highwire.dtl.DTLVardef@1999627org.highwire.dtl.DTLVardef@50ff2aorg.highwire.dtl.DTLVardef@1a0393borg.highwire.dtl.DTLVardef@d69f1_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1.C_FLOATNO Variables analyzed per epidemiological week. (A) pediatric emergency visits for acute respiratory infections (PED-ARI) in Chile. Historical cohort, 2015-2019 average, and consecutive weeks of pandemic, 2020 and 2021. (B) Variation between historical cohort and consecutive weeks of the pandemic, 2020 and 2021, for PED-ARI; (C) National mobility variation per epidemiological week during 2020 and 2021. (0) First COVID-19 case in Chile; (1) Mandatory School closure (2) Partial quarantines in high incidence counties; (3) National Catastrophic Disaster declaration; (4) total quarantine in major urban areas; (5) DELTA variant identified in Chile; (6) Universal Vaccination for > 16 yo; (7) Vaccination for > 12 yo; (8) Non-mandatory in-person schooling; (9) Sanitary passport for vaccination proof in >17 yo; (10) Vaccination for children 12-17 yo; (11) Vaccination for children 6-11 yo; (12) Sanitary Passport for children (12-17 yo); (13) Omicron first case in Chile; (14) Vaccination for children 3-5 yo. C_FIG The correlation between mobility and PED-ARI visits showed a strong monotonic relationship (quadratic) with a Spearmans rho of 0.80 (95% CI 0.75 to 0.86) (Figure 2). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=53 SRC="FIGDIR/small/22276017v1_fig2.gif" ALT="Figure 2"> View larger version (14K): org.highwire.dtl.DTLVardef@a6546corg.highwire.dtl.DTLVardef@1f08804org.highwire.dtl.DTLVardef@71f2e5org.highwire.dtl.DTLVardef@101a1d8_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 2.C_FLOATNO Correlation between national change in mobility (%) and the relative reduction in pediatric emergency department visits for acute respiratory infections (D PED-ARI). Spearmans Rank Test, Spearmans rho of 0.80 (95% CI 0.75 to 0.86). C_FIG ConclusionNPI resulting in a decrease in mobility should be considered a robust public health measure to relieve the winters collapse of the national health system, decreasing morbimortality in children due to PED-ARI. WHATS KNOWN ON THIS SUBJECTA remarkable decrease in pediatric respiratory infections has been described during the pandemic, although the causes are still poorly understood. WHAT THIS STUDY ADDSIn a historical cohort before the pandemic, we observed a temporal association between mid-winter holidays and the gap between the two peaks of acute pediatric respiratory infections. We found a strong correlation between national mobility changes due to non-pharmaceutical interventions and acute pediatric respiratory infections during the pandemic. Therefore, timely implementation of non-pharmaceutical interventions might be considered as a robust public health measure to attenuate the seasonal epidemic of non-COVID viral acute respiratory infections. With these data, we wonder if the time has come to implement non-pharmaceutical interventions to mitigate the stress, and frequently collapse, of national health systems due to the increase in pediatric acute respiratory infection, placing children as a priority, and provide the best care to this vulnerable population.