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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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July 27, 2022 | Volume 13 | Issue 30 |
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Long-term immune response to SARS-CoV-2 infection among children and adults after mild infection
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Anti-receptor-binding domain (RBD) antibodies against SARS-CoV-2 spike (S) protein following SARS-CoV-2 infection correlate strongly with neutralizing antibodies (NAbs) measured, and provide a reproducible, cost-effective and precise tool to define the quality of a host’s immune response against the virus.
Current knowledge of the long-term persistence of SARS-CoV-2 antibodies (up to 12 months after infection) is “mainly limited to adults” and few studies have reported on the production of NAbs and anti-S RBD IgG in children (8 to 12 months after infection) who have recovered from asymptomatic or mild COVID-19.
A single center, prospective cohort study of families (659 children, older siblings and their parents) who attended a Covid-19 Family Cluster follow-up clinic and who were enrolled (April 1, 2020, August 21, 2021) for longitudinal and serologic evaluation at 1 to 4, 5 to 9 and/or more months (up to 18 months) after baseline, studied long-term persistence of SARS-CoV-2 antibodies.
Longitudinally measured S-RBD IgG titers differ among age classes with higher levels of antibodies found in children younger than 3 years of age (5-fold higher than in adults).
In children and adults infected with SARS-CoV-2, S-RBD IgG antibodies persist to 12 months post- infection in all age groups, with significantly higher antibody peaks for the youngest children (though antibodies show strong cross-reactivity to different SARS-CoV-2 variants, future studies are required to assess the longitudinal antibody response to omicron).
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Read the full article at JAMA Network
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Parechovirus (PeV); A CDC Health Advisory |
Parechoviruses are a group of common viruses (4 species), closely related to enteroviruses, (whose hosts include humans, ferrets and various rodents) of which PeV-A (multiple types) only causes disease in humans. It spreads through respiratory (for 1-3 weeks) or gastrointestinal (up to 6 months) contact.
Clinical manifestations vary from asymptomatic to upper respiratory tract infections, fever and rash (common in children 6 months to 5 year of age, with most children being infected by the time they reach kindergarten), to serious illness (often associated with PeV-A3 infection) which occurs in infants <3 months of age who frequently present with a sepsis-like illness, seizures and meningitis / meningoencephalitis (spinal fluid, particularly in infants < 1 month of age, may have no or few white blood cells).
There is no specific treatment for PeV infection and long-term deleterious neurodevelopmental outcomes are rare.
The Health Advisory informs clinicians that PeV is currently circulating in multiple US states; requests clinicians to include PeV as a differential diagnosis in infants/children presenting with signs/systems listed above, asks physicians to familiarize themselves with specimen collection etc. for testing, and reminds all managing an infected infant/child to use contact, droplet and other precautions.
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Trial of erythropoietin for hypoxic-ischemic encephalopathy (HIE) in newborns |
Neonatal HIE may have devastating effects on the newborn; many die, and survivors may suffer long-term disability.
Erythropoietin is the hormone that regulates red cell production by binding to erythroid progenitor cells, promoting their survival and differentiation to mature erythrocytes. In response to hypoxia, high levels of erythropoietin are produced which has been hypothesized to have neuroprotective effects on the brain. Its therapeutic effects on neurodevelopmental outcomes when given in conjunction with therapeutic hypothermia, are unknown.
A multicenter, double-blind, placebo-controlled study randomized 500 infants to receive (within 26 hours after birth and at 2, 3, 4 and 7 days of age) either erythropoietin (1000 units per kg body weight) or saline placebo. Outcomes (death or neurodevelopmental disability) were assessed at 22-36 months of age.
Erythropoietin administered to newborn-infants undergoing therapeutic hypothermia DOES NOT result in less death or less neurodevelopmental impairment (but is associated with a higher rate of serious adverse incidents).
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Clinical spectrum of children with Acute Hepatitis of unknown cause |
From a retrospective follow up study of 44 children (median age 4 years) referred to a single Pediatric Liver Transplantation center in the UK with a diagnosis of confirmed acute hepatitis (NOT due to Hepatitis A through E, or due to metabolic, inherited or genetic, congenital or mechanical causes) which reviewed medical records, demographic characteristics, clinical features, liver biochemical, serologic and molecular tests (30) for hepato-tropic and other viruses, as well as radiologic and clinical outcomes, it appears that common presenting features include jaundice (93%), vomiting (54%) and diarrhea (32%); 90% test positive for adenovirus; fulminant liver failure develops in 14% (all received successful liver transplants) and no patient died.
Children presenting with acute fulminant hepatitis most frequently have human adenovirus isolated, with its role in the pathogenesis remaining unclear.
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A study of postoperative complications occurring at home with pediatric gastrostomy feeding tubes (G-tubes) |
“Approximately 1.4 million children are born in the United States each year with a condition that necessitates assisted feeding, including 25% of normally developing children and 35% of children with neurodevelopmental disabilities”. Although complications associated with G-tube feeding are commonly seen, their prevalence and outcomes remain relatively unstudied.
From a duel-round survey of 98 G-tube-fed children it appears that infection (56%), itching/irritation/redness (52%), and leakage (51%) are the commonest complications encountered.
G-tubes appear to need replacement every 3-4 months (average time recommended is 6 months) with displacement being particularly perceived as critical, frequently preceding other prevalent adverse situations like gastric leakage, infection and tissue granulation.
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First cases of newest Omicron subvariant reported in the US |
While Omicron variant BA.5 continues to create the latest wave of infection in the US (80% of new cases to date) a new and potentially more infectious variant (with a better ability to escape vaccines) BA.2.75 is rising in prominence and competing with BA.5 in India as the most contagious strain. So far, its potential in the US is unknown as, at present, it accounts for <1% of new cases.
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A trial of intranasal corticosteroids (INCs) to treat childhood Obstructive Sleep Apnea Syndrome (OSAS) |
From a double-blind, placebo-controlled trial of 134 children with OSAS randomized (2:1) to receive either 3 months of INC or placebo, with potential changes in symptoms, polysomnography and neurobehavior being measured (baseline, 3 months and at 12 months following therapy), it appears that children with OSAS do not benefit clinically from a 3-month course of INC.
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At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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