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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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August 3, 2022 | Volume 13 | Issue 31 |
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Post-COVID-19 conditions among children 90 days after SARS-CoV-2 infection |
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Post-COVID-19 conditions (PCCs) have been, and continue to be described in adults (often, however, occurring in serologically-negative people!). PCCs in children remain poorly outlined and while early estimates indicated 25-58% of children may experience PCCs after an acute illness (independent of severity) later studies suggest a prevalence of 2-4%.
“A comprehensive understanding of pediatric PCCs is required to inform public health policies and guide the care of high-rick children”.
A prospective multinational cohort of 1,884 SARS-CoV-2 positive (vs. negative) children who visited an Emergency Department (ED) and completed a follow-up survey identified persistent, new or recurrent healthcare problems at 90-day post-infection.
5.8% of SARS-CoV-2 positive children report PCCs at 90 days post-infection. Most commonly reported symptoms include respiratory, fatigue or weakness. Characteristics associated with at least 1 PCC include being hospitalized (particularly with severe symptoms), having >4 symptoms at initial ED visit (e.g., fever, cough, rhinorrhea/congestion) and being 14 years of age or older.
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Read the full article at JAMA Network Open
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Efficacy and safety of ciprofloxacin (Cipro) plus fluocinolone acetonide (Fluo) among patients with acute otitis externa (AOE) |
Acute otitis externa is a common condition with an estimated incidence of between 1:100 and 1:200 of the general population. Its pathogenesis is multifactorial with water exposure in the ear canal commonly noted, and Pseudomonas aeruginosa and Staphylococcus aureus identified. Clinically children frequently present with otalgia, tenderness, diffuse ear canal edema and otorrhea. Current guideless recommend treatment with topical antimicrobial agents with or without anti-inflammatory drugs, pain management and risk factor avoidance.
A phase 3 randomized double-blind clinical study of 493 patients >6 months of age with AOE, <21 days duration investigated and compared Cipro 0.3% plus fluocinolone acetonide 0.025% to Cipro 0.3% or fluocinolone acetonide alone, and stratified results by age.
Clinical cure and improved pain and microbiological outcomes occur more frequently with Cipro plus Fluo compared to either Cipro or Fluo alone (as secondary efficacy end points).
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The host response to Influenza A virus and SARS-CoV-2 replication during co-infection |
SARS-CoV-2 and Influenza A (IAV) viruses (both RNA viruses) have high pandemic capabilities and as both infect the respiratory system, the likelihood of co-infection resulting in substantial increases in morbidity and mortality is significant (particularly as more than half of the 30 proteins encoded in the SARS-CoV-2 genome have been reported to counteract interferon (IFN) induction and signaling).
Competition-assays in vitro in susceptible cells, in additional to an in vivo golden hamster model was utilized to investigate the interaction between SARS-CoV-2 and Influenza H1N1 A/California/04/2009 virus during coinfection.
SARS-CoV-2 infection does not interfere with IAV biology however IAV infection results in a significant loss of SARS-CoV-2 replication (which correlates with increased levels of IFN-I/-III and “immune priming”, found).
“…cocirculation of SARS-CoV-2 and IVA is unlikely to result in increased severity of disease.
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Use of electronic cigarettes (e-cigs) among cannabis-naïve adolescents and its associations with future cannabis use |
There appears to be a strong association between e-cigarette use and later cigarette smoking (though variables may decrease this!). Earlier studies (2013-2017) have also indicated an association between e-cigs. and cannabis use; little is known about this association from 2017 onwards.
From the Population Assessment of Tobacco and Health (PATH) study (and a nationally representative cohort) a study sample of 9,828 cannabis-naïve adolescents at baseline (2017-1019) was utilized to assess the effect of e-cigarette use (assessed by “ever use”, “past-12-month use”, and “past 30-day use”) in adolescents >12 years of age on future cannabis utilization.
There appears to be a strong association between adolescent e-cigarette use and subsequent cannabis use “at the individual level”.
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Effectiveness of homologous and heterologous boosted doses for an inactivated SARS-CoV-2 vaccine (Mix-and-Match COVID-19 boosters after inactivated virus vaccine) |
A prospective, observational, national level cohort of individuals (>16 years of age) assessed the effectiveness on outcomes for CoronaVac (Sinovac Biotech – a whole inactivated virus vaccine) vs. a mRNA-based vaccine BNT162B2 (Pfizer BioNTech) or a recombinant booster AZD1222 (Oxford-Astra Zeneca) to protect against COVID-19 in individuals who had completed a primary immunization schedule with CoronaVac.
A homologous or heterogenous booster dose of vaccine in individuals who have completed primary vaccination (with CoronaVac) provides a high level of protection against severe disease and death. Using heterologous boosters provides HIGHER vaccine effectiveness, “providing support for a Mix-and-Match approach.
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Analysis of neonatal neurobehavior and developmental outcomes among preterm infants |
A large multi-center and very comprehensive prospective study of 556 infants born before 30 weeks' gestation from 9 US university-affiliated Neonatal Intensive Care Units (NICUs) evaluated whether neurobehavioral patterns exhibited during the week of NICU discharge are associated with behavioral and neurodevelopmental impairment at age 2 years.
Preterm infants who at NICU discharge have high risk neurobehavioral profiles and varying medical complications are 4 times more likely to have motor delay, nearly 3 times more likely to have cognitive deficits and 2 times more likely to have behavioral issues at 2 years of age (Article well-worth reading, ED.)
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Association of outpatient oral macrolide use and sensorineural hearing loss in children, adolescents and young adults |
From a retrospective case-controlled study of 875 matched-pairs of essentially healthy children receiving an outpatient course of an oral macrolide antibiotic (e.g., erythromycin, azithromycin etc.) vs. those receiving a penicillin-class antibiotic which evaluated for the odds of developing sensorineural hearing loss (SNHL) from ototoxicity, it appears that with macrolide treatment there is a 31 % increased likelihood of developing new SNHL, which increases over post-exposure time.
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