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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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September 8, 2021 | Volume 12 | Issue 36 |
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One-year Outcomes in
Hospital Survivors of COVID-19
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“As of early august 2021 more than 200 million COVID-19 cases have been confirmed globally and more than 4.3 million people have died”. In the USA younger adults and children are being increasingly affected and with school opening it is anticipated that infections and hospital admission will increase. While most people who have COVID-19 recover completely, physical, psychological and social sequalae after recovery has been widely reported, with 75% of COVID-19 survivors discharged from hospitals having persistent symptoms 6 months after symptom onset (Long COVID). Little information is available on longer term outcomes.
A bidirectional (2-phase study) cohort study of 1,276 hospitalized COVID-19 survivors compared sequalae (to non-COVID-19 matched controls) 6 months and 12 months after symptom onset. 68% of hospitalized adults discharged following COVID-19 have at least 1 symptom at 6 months post onset which decreases to 49% by 1 year (reported dyspnea remaining unchanged over that time period and anxiety/depression increasing over time. Women have more muscle weakness, pain/discomfort, anxiety/depression and poorer lung function).
Though the health of post-COVID-19 survivors is poorer than the control population, most have good physical and functional recovery by 1 year follow-up.
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Read full article at The Lancet
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Examining the potential benefits of the influenza vaccine against SARS-CoV-2
A retrospective outcome study of 2 cohorts of 37,377 patients each of whom either received or not, influenza vaccination 6 months – 2 weeks priors to SARS-CoV-2 diagnosis, indicates a potential protective effect of influenza vaccination on SARS-CoV-2 symptomatology by mitigating against sepsis, deep vein thrombosis and Emergency/Intensive Care admission.
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Cervicovaginal microbiota and metabolome predict preterm birth risk |
“Preterm birth (PTB) is a leading cause of infant morbidity and mortality in the USA and globally”, and remains among the most complex and important challenges in obstetrics. PTB may be “Spontaneous” (SPTB – 50%) or “Indicated” (25%-due to abnormalities associated with maternal or fetal conditions). Many factors are associated with SPTB (e.g., being Black, non-Hispanic race and ethnicity, age of mother, short interval between pregnancies, previous preterm labor or premature birth, some infections, stress, etc.). Mechanisms involved appear complex and are not fully understood but may be associated with the vaginal microbiome, metabolome and innate immune responses.
A study of 346 ethnically heterogenous pregnant women <37 weeks gestation analyzed cervicovaginal samples to identify novel interactions between risk of SPTB and microbiota, metabolites and maternal host defense molecules.
It appears that a composite of the presence of leucine, tyrosine, aspartate, and calcium with abundance of Lactobacillus (L) crispatus and L. acidophilous identifies risk of early SPTB in infants <34 gestation.
Cervicovaginal fluid sample analysis demonstrates the importance of the vaginal environment as a contributor to spontaneous preterm birth.
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Associations between variations in breast anatomy and early breastfeeding challenges |
“Despite the unparallel benefits of breastfeeding for infants, mothers and families only 13% of the population of the USA meets the American Academy of Pediatrics breastfeeding recommendations”. Unsuccessful initiation of breastfeeding is a significant factor for many mothers’ failure to breastfeed with difficulties in establishing effective latch and sore and/or cracked nipples being common factors involved. Early breastfeeding challenges may also be due to initial disparity between maternal and infant anatomy.
A cross-sectional observational study of 115 mothers with infants 6 weeks of age or younger examined whether variations in breast anatomy (nipple base width, length, and areolar density) are associated with early risk of breastfeeding difficulties.
A combination of wider and longer nipples is associated with greater risk for difficulties to latch; wider nipples and denser areolae are associated with a greater risk for sore nipples. Other combinations of nipple length and areolar density affect milk supply and slower infant weight gain.
Variations in breast anatomy of mothers attempting to breastfeed appears to play a role (with other risk factors) in breastfeeding difficulties. Anticipatory guidance and targeted interventions may decrease breastfeeding challenges.
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Association of age and pediatric household transmission of SARS-CoV-2 infection |
From an elegant and extensive study of 6,280 households which examined the odds of household transmission of SARS-CoV-2 by an infected younger child it appears that children aged 0-3 years have the highest (43%) odds (compared to children 14-17 years of age) of transmitting SARS-CoV-2 to household contacts (with children aged 4-8 years having a 40%, and children 9-13 years a 13% higher rate of transmitting the virus).
The challenge in families with young children is how to minimize intra-family SARS-CoV-2 spread, and what to advise a family with a young Covid positive child. Obviously socially isolating a sick child is impractical, however separating siblings, and requiring all household persons apply other infection control measures (masks, hand washing, and in particular, vaccinating all adults/older children), is imperative.
JAMA Pediatrics
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Myocarditis and pericarditis after vaccination for COVID-19 |
Of 2,000,287 individuals receiving at least 1 COVD-19 vaccination (median age 57 years) of whom 96.7% received mRNA (Pfizer-BioNTech or Moderna) vaccine, 20 individuals (1 per 100,000 or 001%) had vaccine-related myocarditis (males, median age: 36 years) which occurred 3.5 days (mean) after vaccination (4 days after the first and 16 after the second vaccine dose). All were admitted to hospital (median length of stay: 2 days) with no readmissions or deaths.
Pericarditis develops either after the first or second immunization (73% males, median age: 59 years) with onset 20 days (median) after the most recent vaccination. 35% are admitted to hospital (median length of stay: 1 day) with no deaths or recurrences occurring.
Myocarditis or pericarditis after COVID-19 vaccination is rare. 2 distinct self-limiting syndromes occur with myocarditis affecting younger males mostly after the second vaccination and pericarditis affecting older males later after either dose.
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Sudden death in the Young: Information for the Primary Care Provider |
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“There are multiple conditions that can make children prone to having a sudden cardiac arrest (SCA) or sudden cardiac death (SCD)”. An update by the American Academy of Pediatrics addresses prevention of SCA /SCD by firstly reminding us that ALL children (not only athletes) need to have cardiac screening at a minimum every 2-3 years from ages 6-21 years using a 14-point history and physical screening tool (or a basic 4 question protocol). A positive response requires further cardiology/electrophysiology investigation.
Children with cardiomyopathies, channelopathies, congenital heart disease, Wolf-Parkinson-White syndrome, Commotio Cardis (a chest impact that causes ventricular fibrillation), anomalous coronary arteries and aortopathies are at increased risk for SCA/SCD independent of whether they are athletes or not. All children should be regularly screened and referred when necessary for appropriate cardiac evaluation.
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Mayo Clinic COVID-19 Vaccine Tracker |
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COVID-19 VACCINE & TREATMENT UPDATES – DISPELLING THE MYTHS
This Virtual Grand Round was recorded LIVE and includes the post-session Q&A portion. This content is available for free - without CME credit (Fee may apply for those who wish to claim CME).
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Nicklaus Children's Hospital Video Feature |
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Underwriting Opportunities
Advertising in this e-journal in no way implies endorsement of a product by Nicklaus Children's Hospital.
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