Emergency department visits and hospitalizations for pediatric vaso-occlusive pain events during the COVID-19 pandemic

The coronavirus SARS-CoV-2 (COVID-19) pandemic altered all aspects of life, including healthcare. During the pandemic, social distancing led to decreased transmission of typical viral illnesses, leading to a decrease in these pediatric admissions. Studies have shown that pediatric emergency department (ED) visits and hospitalizations decreased during the pandemic, which may have led to some unmet healthcare needs and delays in treatment. Little is known about the effect of the COVID-19 pandemic on ED visits and hospitalizations specifically for pediatric sickle cell pain. A retrospective review across hospitals in the Northwell Health system was conducted to compare the ED visits and hospitalizations for pediatric patients with sickle cell pain during 2020 (the year of the pandemic), the following year (2021), and the 2 years prior to the pandemic (2018, 2019). The average length of stay for patients hospitalized with vaso-occlusive events was also compared between these years. Total 511 patient encounters for patients seen and discharged home from the ED and 985 hospitalization encounters were included over the 4-year timespan. ED visits per year decreased significantly in 2020 compared with the 2 years prior (p < .001): 91 visits in 2020, 162 visits in 2019, and 143 visits in 2018. The number of ED visits for pediatric vaso-occlusive events trended upward in 2021 to 115. Hospitalizations also decreased in 2020 compared to the 2 years prior (n = 202 vs 196; p < .001), compared with 298 in 2019 and 289 in 2018. The number of patients hospitalized remained stable in 2021 (n = 202 vs 196). There was a statistically significant increase in the median length of stay in 2020 compared to years prior (p = .002): median (interquartile range [IQR]): 4.0 days (2–6 days) in 2020 compared to 3.0 days (2–5 days) in 2018 and 2019. ED encounters and hospitalizations for pediatric patients with sickle cell disease pain decreased during the pandemic; however, admitted patients had a longer median length of stay.     

Childhood injuries in an urban area of Ghana A hospital-based study of 677 cases

To the best of our knowledge, there has not been any recent available study of trauma-related hospitalisation of paediatric patients in an urban area of the sub-Saharan countries. Accidental injury, especially among children, has become one of the most serious major health problems facing developing countries, including those in sub-Saharan Africa. We reviewed 677 children admitted to the Komfo Anokye Teaching Hospital in Kumasi, Ghana, from August 1995 to July 1996 to elicit the incidence of various injuries, causes, rates of injury, and survival of children aged 0 to 14 years who had sustained trauma during this period. The most common mechanisms of injury were pedestrian knockdowns (40.0%), falls (27.2%), and burns (17.6%). The annual rate of injury was 230/100 000 children. Boys sustained higher injury rates in all age groups than girls, with an overall rate of, 136/100 000 children as compared to 92/100 000 for girls. Rates of injury were higher for children over 5 years of age in six of the seven specific causes of injury studied. When analysing the region of principal injury, for severe injuries (abbreviated injury scale 3–5) the extremities suffered most, followed by the skin and head. There was increased mortality for patients with an injury severity score >20. The overall mortality for this study was 5.5%. There is, therefore, a need to establish prevention priorities and to design effective prevention strategies for children of school-going age, who are most at risk of sustaining trauma. Accepted: 24 November 1997     

Utilization of chest tube as an esophagus stent in pediatric caustic injuries: A retrospective study

BACKGROUNDThe management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. AIMTo describe how to utilize a chest tube for esophageal stenting in pediatrics.METHODSData regarding the etiology, treatment, and complications of caustic injury in pediatrics over 10 years was collected retrospectively. Furthermore, data regarding the patient''s follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patient''s cheek.RESULTSDuring the period of our study, data from 57 patients with an average age of 2.5 years (range 1-12; SD = 1.7) were obtained. The results showed that 89% of esophageal injury was due to alkaline and 9.4% were caused by acidic agents. The treatment methods showed that 29 patients (50.8%) recovered with dilatation alone. In 16 patients (28.06%), the esophageal repair was performed by using the colon, and in 5 patients (8.7%), other surgical methods were used and in 7 patients (12.2%), the ECT stents were used. ECT was inserted in 7 cases with a mean age of 2 (range: 1.5-3) years who were classified as grade IIB or III. Grading was performed by endoscopy assessment on the first day. Antibiotics and corticosteroids were administrated as initial medical management for all patients. ECT implantation was done during the first 8 d for 5 out of 7 cases (mean: 3.8 d). For the 2 patients, ECT was used after 27 (patient 6) d and 83 (patient 7) d. The reason for late stenting in these patients was a postponed referral to our center, in which patient 7 even received 4 dilation episodes before visiting our center. ECT was removed after an average of 44 d in the first 5 patients, while in the other 2 patients (6 and 7) was 2 and 1 wk, respectively. There was no complication related to, or failure of, stent placement. It is worth mentioning that none of the 7 ECT cases required gastrostomy or jejunostomy.CONCLUSIONThe ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.     

湖北省某三级甲等医院新型冠状病毒感染流行期间小儿骨科门诊及住院诊疗工作实施经验

2019年12月以来,湖北省武汉市陆续发现了多例新型冠状病毒感染的肺炎患者,随着疫情蔓延,儿童患者的门急诊与住院治疗问题日益显现。本文回顾性分析了华中科技大学同济医学院附属同济医院主院区小儿外科2019年12月30日至2020年2月17日期间出院的全部小儿骨科疾病患者的临床诊疗活动,总结在院病人和门急诊患儿的处置经验。     

A descriptive study of injuries in a pediatric population of North-Eastern Italy

Childhood injuries are a major public health problem in Italy. From a study conducted in 1984, injury rates were found to be higher in Trieste, in the north-east of the country, than in other Italian areas. We conducted a new study to evaluate whether injury rates and patterns have changed in Trieste. There are three emergency rooms (ER) in Trieste. We collected and analyzed information on all injured children 0-16 years of age attending these ER in 2003 (child population 0-16 years of age was 28,000). We calculated the annual injury risk overall and by age. We described characteristics of the children (age, sex) and injuries (place, cause, type, affected body part, severity). 5,928 injured children attended the ER, and the annual injury risk was 21.5%. The home was the most frequent place where injuries occurred, especially among the youngest children. The most commonly injured body parts were the limbs and, among the youngest children, the head and face. Approximately 20% of children had moderate to severe injuries (AIS>1), and less then 3% were admitted to the hospital. In comparison to the previous study, there have been no significant changes in the annual risk of childhood injury and in the injury patterns. On the contrary, we observed a dramatic reduction in the frequency of hospitalization, which is probably attributable to the recent implementation of short observation and to the improvement of diagnostic/therapeutic paths in the ER. In conclusion, childhood injuries are still a relevant public health problem in this Italian area and new efforts are needed to prevent them.     

Screening for depression and help-seeking in postpartum women during well-baby pediatric visits: an integrated review

PurposeThe purposes of this integrated review are to examine the literature on screening for depression and help-seeking behaviors by postpartum women during pediatric well-baby visits; to identify gaps in the literature relating to depression and help-seeking behaviors; and to discuss implications for practice and future research.MethodAn extensive search of primary source documents was conducted in Academic Search Premier, CINAHL, MEDLINE, Mental Measurements Yearbook, PsycINFO, PsycARTICLES, and Women's Studies International using the key words postpartum, postpartum depression (PPD), help seeking, and pediatric setting or pediatrician. Thirty-five articles relevant to help seeking, PPD, and screening in the pediatric setting were included in this review. Research studies included both quantitative and qualitative articles.ResultsPPD affects 10% to 15% of all women after birth. Postpartum women generally do not seek help for depression. Untreated PPD has significant adverse affects on parenting, maternal bonding, and the infant's emotional and behavioral development. Interaction with the woman's obstetric provider ends shortly after the baby's birth. However, interactions with the pediatric office are initiated and continue throughout the infant's first two years of life.DiscussionEarly recognition of PPD and appropriate treatment are imperative for positive maternal-infant outcomes. A majority of women do not seek help for depression from any source. Because mothers have routine interactions with pediatric office staff during the first few years after giving birth, pediatric nurse practitioners and pediatricians have the perfect opportunity to screen and educate women regarding symptoms, treatment, and available resources for PPD.     

Emotional status of children aged 7 to 17 of health workers and in the general population during the COVID-19 pandemic: A cross-sectional comparative study in Belgium

BackgroundWe assessed the mental health of children and adolescents aged 7 to 17 and their parents immediately after the first wave of the COVID-19 pandemic.MethodA survey online was conducted in Belgium between May 29th and August 31st 2020.Results(1) Anxious and depressive symptoms were self-reported by one out of four children and hetero-reported by parents for one out of five children; (2) Anxiety scores were higher in children compared to adolescents; (3) Social introversion scores were significantly higher in adolescents compared to children; (4) No significant differences for anxio-depressive symptoms were found between healthcare worker parents and the other parents. Children's self- or hetero-reported symptoms were not found to be connected to parents’ professional activities.ConclusionsThis cross-sectional survey adds evidence to the impact the COVID-19 pandemic has had on children's and adolescents’ emotional state, in particular on their levels of anxiety and depression.     

COVID-19-associated coagulopathy in children: A multicenter observational cohort study

SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) induces a stark procoagulant state, with many hospitalized adults developing thrombosis despite prophylactic anticoagulation. This study aimed to characterize hemostatic parameters and associated clinical outcomes of COVID-19, such as thrombosis and bleeding, in children and to assess thromboprophylaxis use. This multicenter observational cohort study included 79 patients aged up to 18 years admitted to all pediatric hospitals in Québec, Canada, with SARS-CoV-2 infection during a 5-month period. D-dimers were elevated in 18/19 patients (94.7%) and fibrinogen in 15/26 patients (60%). Eleven patients (13.9%) received anticoagulant thromboprophylaxis. One thrombotic event and one major bleed were observed.