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Background: In March 2020, Ontario instituted a lockdown to reduce spread of the SARS-CoV-2 virus. Schools, recreational facilities, and nonessential businesses were closed. Restrictions were eased through 3 distinct stages over a 6-month period (March to September 2020). We aimed to determine the impact of each stage of the COVID-19 public health lockdown on the epidemiology of operative pediatric orthopedic trauma. Methods: A retrospective cohort study was performed comparing emergency department (ED) visits for orthopedic injuries and operatively treated orthopedic injuries at a level 1 pediatric trauma centre during each lockdown stage of the pandemic with caseloads during the same date ranges in 2019 (prepandemic). Further analyses were based on patients' demographic characteristics, injury severity, mechanism of injury, and anatomic location of injury. Results: Compared with the prepandemic period, ED visits decreased by 20% (1356 v. 1698, p < 0.001) and operative cases by 29% (262 v. 371, p < 0.001). There was a significant decrease in the number of operative cases per day in stage 1 of the lockdown (1.3 v. 2.0, p < 0.001) and in stage 2 (1.7 v. 3.0; P < 0.001), but there was no significant difference in stage 3 (2.4 v. 2.2, p = 0.35). A significant reduction in the number of playground injuries was seen in stage 1 (1 v. 62, p < 0.001) and stage 2 (6 v. 35, p < 0.001), and there was an increase in the number of self-propelled transit injuries (31 v. 10, p = 0.002) during stage 1. In stage 3, all patient demographic characteristics and all characteristics of operatively treated injuries resumed their prepandemic distributions. Conclusion: Provincial lockdown measures designed to limit the spread of SARS-CoV-2 significantly altered the volume and demographic characteristics of pediatric orthopedic injuries that required operative management. The findings from this study will serve to inform health system planning for future emergency lockdowns. Contexte : En mars 2020, l'Ontario a décrété des mesures de confinement afin de réduire la propagation du virus SRAS-CoV-2. Les écoles, les installations récréatives, et les commerces non essentiels ont dû fermer. Les restrictions ont été par la suite progressivement assouplies en 3 phases distinctes sur une période de 6 mois (de mars à septembre 2020). Notre objectif était de déterminer les répercussions épidémiologiques de chaque phase du confinement imposé par les autorités de santé publique sur la chirurgie orthopédique pédiatrique et traumatologique. Méthodes : Nous avons réalisé une étude de cohorte rétrospective pour comparer le nombre de consultations aux services d'urgence pour des blessures orthopédiques, traitées ou non en salle d'opération, dans des centres de traumatologie pédiatrique de niveau 1 pendant chaque phase de confinement avec le nombre de consultations pendant les mêmes périodes de l'année en 2019 (prépandémie). Nous avons effectué des analyses complémentaires en fonction des caractéristiques démographiques de la patientèle, ainsi que de la gravité, du mécanisme et de la localisation des blessures. Résultats : Comparativement à la période prépandémique, la fréquentation des services d'urgence a diminué de 20% (1356 c. 1698, p < 0,001) et le nombre d'interventions chirurgicales, de 29% (262 c. 371, p < 0,001). Nous avons constaté une baisse significative du nombre d'interventions chirurgicales lors de la phase 1 du confinement (1,3 c. 2,0, p < 0,001), ainsi que lors de la phase 2 (1,7 c. 3,0, p < 0,001), mais aucune différence significative n'a été observée lors de la phase 3 (2,4 c. 2,2, p = 0,35). Par ailleurs, nous avons constaté une baisse significative du nombre de blessures survenues sur des terrains de jeux durant la phase 1 (1 c. 62, p < 0,001) et la phase 2 (6 c. 35, p < 0,001), alors que le nombre de blessures occasionnées par des véhicules automoteurs a augmenté (31 c. 10, p = 0,002) lors de la phase 1. Enfin, lors de la phase 3, tous les paramètres démographiques de la patientèle et toutes les caractéristiques des blessures traitées en salle d'opération sont revenus à leurs valeurs prépandémiques. Conclusion : Les mesures de confinement prises au niveau provincial pour limiter la propagation du virus SRAS-CoV-2 ont significativement modifié le volume et les caractéristiques démographiques des blessures orthopédiques pédiatriques nécessitant une prise en charge chirurgicale. Les résultats de cette étude serviront à améliorer la planification du système de santé en cas de nouveau confinement d'urgence., The COVID-19 pandemic has had an unprecedented impact on health care systems. At its height, governments worldwide implemented various public healdi measures to limit exposure to the virus and to [...]

Objective To make a systematic review of risk factors, outcomes and prevalence of extended-spectrum [beta]-lactamase-associated infection in children and young adults in South-East Asia and the Western Pacific. Methods Up to June 2018 we searched online databases for published studies of infection with extended-spectrum [beta]-lactamase-producing Enterobacteriaceae in individuals aged 0-21 years. We included case-control, cohort, cross-sectional and observational studies reporting patients positive and negative for these organisms. For the meta-analysis we used random-effects modelling of risk factors and outcomes for infection, and meta-regression for analysis of subgroups. We mapped the prevalence of these infections in 20 countries and areas using available surveillance data. Findings Of 6665 articles scanned, we included 40 studies from 11 countries and areas in the meta-analysis. The pooled studies included 2411 samples testing positive and 2874 negative. A higher risk of infection with extended-spectrum [beta]-lactamase-producing bacteria was associated with previous hospital care, notably intensive care unit stays (pooled odds ratio, OR: 6.5; 95% confidence interval, CI: 3.04 to 13.73); antibiotic exposure (OR: 4.8; 95% CI: 2.25 to 10.27); and certain co-existing conditions. Empirical antibiotic therapy was protective against infection (OR: 0.29; 95% CI: 0.11 to 0.79). Infected patients had longer hospital stays (26 days; 95% CI: 12.81 to 38.89) and higher risk of death (OR: 3.2; 95% CI: 1.82 to 5.80). The population prevalence of infection was high in these regions and surveillance data for children were scarce. Conclusion Antibiotic stewardship policies to prevent infection and encourage appropriate treatment are needed in South-East Asia and the Western Pacific. Objectif Realiser une revue systematique des facteurs de risque, des consequences et de la prevalence des infections a beta-lactamases a spectre elargi chez des enfants et des jeunes adultes dans les regions de l'Asie du Sud-Est et du Pacifique occidental de l'Organisation mondiale de la Sante (OMS). Methodes Jusqu'en juin 2018, nous avons consulte des bases de donnees en ligne a la recherche d'etudes publiees portant sur des infections par des enterobacteries productrices de beta-lactamases a spectre elargi chez des individus ages de 0 a 21 ans. Nous avons inclus des etudes cas/temoins, de cohortes, transversales et d'observation rendant compte de patients positifs et negatifs a l'egard de ces organismes. Pour la meta-analyse, nous avons utilise une modelisation a effets aleatoires des facteurs de risque et des consequences associes aux infections, et une meta-regression pour l'analyse des sous-groupes. Nous avons analyse la prevalence de ces infections dans 20 pays et regions a l'aide des donnees de surveillance disponibles. Resultats Sur les 6665 articles parcourus, nous avons inclus 40 etudes de 11 pays et regions dans la meta-analyse. Prises ensemble, les etudes incluaient 2411 echantillons declares positifs et 2874 negatifs. Un risque plus eleve d'infection due a des bacteries productrices de beta-lactamases a spectre elargi a ete associe a de precedents soins hospitaliers, et en particulier a des sejours en unite de soins intensifs (RC regroupes: 6,5; IC a 95%: de 3,04 a 13,73); a une exposition aux antibiotiques (en particulier aux cephalosporines de troisieme generation, CR: 4,8; IC a 95%: de 2,25 a 10,27); et a certaines affections concomitantes. Le traitement antibiotique empirique a eu un effet protecteur vis-a-vis des infections (CR: 0,29; IC a 95%: de 0,11 a 0,79). Les patients infectes se caracterisaient par des sejours hospitaliers plus longs (26 jours; IC a 95%: de 12,81 a 38,89) et un risque de deces plus eleve (CR: 3,2; IC a 95%: de 1,82 a 5,80). La prevalence de l'infection dans la population etait elevee dans ces regions et les donnees de surveillance relatives aux enfants etaient alarmantes. Conclusion Des politiques de gestion des antibiotiques pour prevenir les infections et encourager un traitement approprie sont necessaires dans les pays et les regions de l'Asie du Sud-Est et du Pacifique occidental de l'OMS. Objetivo Realizar una revision sistematica de los factores de riesgo, los resultados y la prevalencia de la infeccion de amplio espectro asociada a la betalactamasa en ninos y adultos jovenes en las regiones de Asia Sudoriental y el Pacifico Occidental de la Organizacion Mundial de la Salud (OMS). Metodos Hasta junio de 2018 se realizaron busquedas en las bases de datos en linea de estudios publicados sobre infeccion con Enterobacteriaceas productoras de betalactamasas de amplio espectro en individuos de 0 a 21 anos de edad. Se incluyeron estudios de casos y controles, de cohortes, transversales y observacionales que reportaron pacientes positivos y negativos para estos organismos. Para el metanalisis se utilizo la modelizacion de efectos aleatorios de los factores de riesgo y los resultados en cuanto a la infeccion, y la metarregresion para el analisis de los subgrupos. Mapeamos la prevalencia de estas infecciones en 20 paises y regiones utilizando los datos de vigilancia disponibles. Resultados De los 6 665 articulos examinados, se incluyeron 40 estudios de 11 paises y regiones en el metanalisis. Los estudios agrupados incluyeron 2 411 muestras positivas y 2 874 negativas. Un mayor riesgo de infeccion con bacterias productoras de betalactamasas de amplio espectro se asocio con la atencion hospitalaria previa, en particular las estancias en unidades de cuidados intensivos (OR agrupado: 6,5; IC del 95%: 3,04 a 13,73); la exposicion a los antibioticos (especialmente las cefalosporinas de tercera generacion, OR: 4,8; IC del 95%: 2,25 a 10,27); y ciertas enfermedades coexistentes. El tratamiento antibiotico empirico fue protector contra la infeccion (OR: 0,29; IC del 95%: 0,11 a 0,79). Los pacientes infectados tuvieron estancias hospitalarias mas prolongadas (26 dias; IC del 95%: 12,81 a 38,89) y mayor riesgo de muerte (OR: 3,2; IC del 95%: 1,82 a 5,80). La prevalencia de la infeccion en la poblacion era alta en estas regiones y los datos de vigilancia para los ninos eran alarmantes. Conclusion Se necesitan politicas de gestion de los antibioticos para prevenir la infeccion y fomentar el tratamiento adecuado en los paises y zonas de las regiones de Asia Sudoriental y el Pacifico Occidental de la OMS., Introduction Antimicrobial resistance occurs when bacteria are no longer susceptible to the drugs used for treatment. (1) Increasingly, there are fewer antimicrobial drugs available to effectively treat common as well [...]

Purpose There are no data on the prevalence and predictors of difficult intubation (DI) in pediatric patients with thyroid disease. This study (1) assesses the prevalence of DI in patients with thyroid disease undergoing elective operations, (2) identifies other predictors of DI in children, and (3) evaluates the effect of DI on postoperative care and length-of-stay. Methods A single-center retrospective cohort analysis of procedures in patients assigned with an ICD-9 code for thyroid disease between June 2012 and February 2016. A comparative group was created which comprised of patients without thyroid disease receiving orthopedic or urologic surgeries to determine differences in DI prevalence. Univariate analyses compared demographics and intubation details between groups, and logistic regression identified independent variables associated with DI. Patients with and without DI were compared based on procedure duration, PACU-LOS, and escalation-of-care. Results DI prevalence was greater in the thyroid group (4.9%, 51/1046) compared to the non-thyroid group (2.6%, 33/1289) (OR 1.95, 95% CI 1.25-3.05; p = 0.003). DI was associated with younger age, higher American Society of Anesthesiologists (ASA) class, and smaller body habitus (p < 0.001 for all comparisons). Congenital hypothyroidism (OR 2.49, 95% CI 1.44-4.32; p = 0.002)) and acquired hypothyroidism (OR 2.20, 95% CI 1.42-3.41; p < 0.001) were seen in a greater proportion of DI patients. After adjustment for demographic confounders, age and ASA class were independently associated with DI (p < 0.05), while hypothyroidism did not reach statistical significance (p = 0.077). Direct laryngoscopy (DL) was most frequently used as the successful subsequent maneuver in securing the airway in DI patients. A longer PACU length-of-stay was seen after procedures with DI (p < 0.001). Conclusion Elective pediatric surgical patients with thyroid-related diagnoses at our institution had a higher prevalence of DI than those without thyroid disease, but this finding could not be isolated to thyroid pathology. Repeat DL achieves successful intubation in the majority of DI patients. DI patients often require longer recovery times due to prolonged cardiopulmonary monitoring., Author(s): Aalap C. Shah [sup.1] [sup.3] , William C. K. Ng [sup.2] , Sean Sinnott [sup.1] , Joseph P. Cravero [sup.1] Author Affiliations: (1) Department of Anesthesiology, Perioperative and Pain [...]

Purpose The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children. Methods Multicenter cohort study including children 2 mmol/l discriminated poorly (AUC Conclusions We observed mortality patterns specific to pediatric sepsis that support the need for specialized definitions of sepsis severity in children. We demonstrated the importance of lactate, cardiovascular, and respiratory derangements at ICU admission for the identification of children with substantially higher risk of sepsis mortality., Author(s): Luregn J. Schlapbach [sup.1] [sup.2] [sup.3], Graeme MacLaren [sup.4] [sup.5], Marino Festa [sup.6], Janet Alexander [sup.7] [sup.8], Simon Erickson [sup.9], John Beca [sup.10], Anthony Slater [sup.2], Andreas Schibler [sup.1] [...]

Purpose Use of systemic corticosteroids in acute respiratory distress syndrome (ARDS) remains controversial, and studies in children are lacking. Methods We performed an observational, single-center study in a prospectively enrolled cohort of children meeting criteria for ARDS (both Berlin 2012 and AECC 1994 acute lung injury) and pediatric ARDS (PARDS, as defined by PALICC 2015). Comprehensive analysis of corticosteroid utilization was planned, and detailed information collected on corticosteroid use, timing, treatment duration, and cumulative dose while mechanically ventilated. We assessed the association between corticosteroid exposure >24 h and outcomes. Results Of the 283 children with PARDS (37 deaths, 13 %), 169 (60 %) received corticosteroids for >24 h while ventilated: 51 % hydrocortisone, 41 % methylprednisolone, 5 % dexamethasone, 3 % combination of corticosteroids. Corticosteroid exposure >24 h was associated with increased mortality, fewer ventilator-free days at 28 days (VFD), and longer duration of ventilation in survivors in unadjusted analyses (all p 24 h in patients with [greater than or equal to]3 organ failures and immunocompromised patients. Conclusions Corticosteroid exposure >24 h was independently associated with fewer VFD and longer duration of ventilation in survivors, even after adjustment for key potential confounders, including severity of illness, oxygenation index, immunocompromised status, and number of organ failures., Author(s): Nadir Yehya [sup.1], Sabah Servaes [sup.2], Neal J. Thomas [sup.3], Vinay M. Nadkarni [sup.1], Vijay Srinivasan [sup.1] Author Affiliations: (1) grid.239552.a, 0000000106808770, Department of Anesthesiology and Critical Care Medicine, [...]

Objective To determine the association between organ dysfunction and hyperglycemia in critically ill children receiving intravenous insulin. Design Retrospective chart review (cohort study). Setting Pediatric intensive care unit in a university hospital. Patients n = 110 patients; inclusion criteria: ICU hospitalization from May 2005 to May 2006; insulin drip to manage hyperglycemia. Exclusion criteria: insulin drip Measurements Duration of hyperglycemia: sum of hours of hyperglycemia ([greater than or equal to]126 mg/dl). Hypoglycemia (blood glucose Main results Organ dysfunction [greater than or equal to]3 compared to Conclusions Organ dysfunction ([greater than or equal to]3 versus, Author(s): Ursula G. Kyle [sup.1], Jorge A. Coss Bu [sup.1], Curtis E. Kennedy [sup.1], Larry S. Jefferson [sup.1] Author Affiliations: (1) grid.39382.33, 000000012160926X, Pediatric Critical Care Medicine, Texas Children's Hospital, [...]

Byline: Nand. Gora, Ashok. Gupta, Virendra. Sinha Aim: Cerebellar mutism (CM) syndrome is a well-known and annoying complication of posterior fossa surgery in the pediatric age group. Risk factors such [...]

* Context.--Helicobacter pylori infection is primarily acquired during childhood and persists throughout life in the absence of eradication with antibiotics. Helicobacter pylori infection induces methylation in the promoter CpG island loci in gastric epithelial cells. Thus, aberrant CpG island hypermethylation in gastric epithelial cells likely occurs early in life, although there are no existing data supporting this notion. Objectives.--To identify whether aberrant CpG island hypermethylation occurs in pediatric stomach mucosa in association with H pylori infection and to compare methylation profiles of samples from pediatric and adult stomach tissues. Design.--We analyzed pediatric (n = 47) and adult (n = 38) gastric mucosa samples for their methylation status in 12 promoter CpG island loci using the MethyLight assay and compared the number of methylated genes and the methylation levels in individual genes between H pylori-positive and H pylori-negative sample results and between pediatric and adult samples. Results.--The average number of methylated genes was significantly higher in H pylori-infected pediatric samples than in H pylori-negative pediatric samples (3.4 versus 0.3, P < .001) and in H pylori-infected adult samples than in H pylori-negative adult samples (7.6 versus 0.9, P < .001). Seven genes showed significantly higher methylation levels in H pylori-infected pediatric samples than in H pylori-negative pediatric samples (all values were P < .05). Conclusions.--These results indicate that CpG island hypermethylation occurs in pediatric gastric mucosa in association with H pylori infection and that the genes affected by H pylori-associated hypermethylation were similar in pediatric and adult samples., CpG islands are CpG-rich DNA sequences that are found in the promoters and 5' exon sequences of approximately 60% to 70% of human genes. (1) In association with tumorigenesis, promoter [...]

Haines C, Perrott M, Weir P (2006) Promoting care for acutely ill children--development and evaluation of a Paediatric Early Warning Tool. Intensive and Critical Care Nursing. 22, 2, 73-81. Aim [...]