On Passover, when my family gets together to recount the telling of the exodus from Egypt, there is the recitation of the 10 plagues that the Lord brought down on the people of Egypt, among which are Blood, frogs…death of the first born. I’ve got to admit that I thought of these plagues like fairy tales… Well, I’m not so sure anymore. Granted, the water hasn’t turned bloody and frogs haven’t fallen from the sky but it sure feels like we are re-living those biblical times. Covid, obesity, diabetes, opioid overdose deaths, climate change, burnout, the death of democracy…you get the idea. Today’s PAAD describes a retrospective analysis of factors associated with hospitalization of children with Covid in the first year of the plague. I’ve also included a previously discussed PAAD on the anesthetic implications of Covid Myron Yaster MD
Jerry Y Chao, Ariel Sugarman, Atsumi Kimura, et al. Factors Associated With Hospitalization in Children and Adolescents With SARS-CoV-2 Infection. Clin Pediatr (Phila). 2021 Nov 18;99228211059883. PMID: 34789028
Rita Saynhalath, Gijo Alex, Proshad N Efune, Peter Szmuk, et al. Anesthetic Complications Associated With Severe Acute Respiratory Syndrome Coronavirus 2 in Pediatric Patients. Anesth Analg. 2021 Aug 1;133(2):483-490. PMID: 33886516
Dr. Chao, a pediatric anesthesiologist and his colleagues at the Montefiore Medical Center, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY retrospectively reviewed 319 laboratory confirmed cases of pediatric Covid admitted to Montefiore Children’s Hospital. Let’s cut to the chase: the biggest risk factors? Obesity and diabetes. Or from the movie Casablanca: “I’m shocked, just shocked, to find gambling is going on here”
Asthma, race, ethnicity, gender and lower socioeconomic status were not found to be contributory to hospitalization.
“Fever, fussiness, or a history of fatigue or decreased energy level were constitutional symptoms significantly more prevalent among pediatric patients who required hospitalization. Shortness of breath was the only pulmonary symptom found to be more prevalent among hospitalized children, as well as multiple gastrointestinal symptoms: abdominal pain, nausea and vomiting, and diarrhea. Decreased urination, conjunctivitis, and rash were also significantly more prevalent presenting symptoms among children who were admitted for SARS-CoV-2 infection compared with those who were not. More patients required initial supplemental oxygen in the hospitalized group (30.6% vs 0%, P < .001) with a median initial fraction inspired oxygen of 0.6. Of the 26 hospitalized patients who required supplemental oxygen, nasal cannula was used in 57.7%, a facemask non-rebreather mask was used in 23.1%, high-flow nasal cannula was used in 30.8%, and 34.6% required endotracheal intubation”.
Finally, “they observed a bimodal distribution of age: with a substantial proportion of infants <1 year of age presenting with fever who were admitted empirically in the setting of SARS-CoV-2 infection. Many of these patients required admission as part of evaluations to “rule out sepsis,” especially newborns <30 days of life given their increased risk of serious bacterial infection. The threshold for admission for older infants (≥60 days old) may also have been lower early in the pandemic when the pathophysiology and disease course of SARS-CoV-2 in pediatric patients was not yet known”.
We hope locusts aren’t next; wait, we had those last spring!
Myron Yaster MD and Lynne G Maxwell MD