The Journal of Pediatrics

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Practical School Algorithms for Symptomatic or SARS-CoV-2-Exposed Students Are Essential for Returning Children to In-Person Learning

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the well-being of children as a result of the widespread closure of schools. Throughout the summer, states have allowed the reopening of many businesses including restaurants, bars, retail locations, and amusement parks, including in locations experiencing surges in cases. Meanwhile, many school districts across the country began the fall semester in a partially or completely virtual fashion.

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https://www.jpeds.com/article/S0022-3476(20)31252-X/fulltext?rss=yes

Congenital Heart Defects and the Risk of Spontaneous Preterm Birth

To estimate the association between major types of congenital heart defects (CHD) and spontaneous preterm birth, and to assess the potential underlying mechanisms.

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https://www.jpeds.com/article/S0022-3476(20)31251-8/fulltext?rss=yes

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In our article, we report high viral load in children infected with SARS-CoV-2 in the first two days of illness. We did not assess viability of virus from these respiratory secretions and agree that RNA does not necessarily correlate with live virus. However, in hospitalized adults, live virus is readily cultured from respiratory secretions during the first week of symptoms.2 It is plausible that differences exists between pediatric and adult immune responses to SARS-CoV-23; distinctions in mucosal immune responses could impact viral detection by RT-PCR and/or severity of symptoms.

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https://www.jpeds.com/article/S0022-3476(20)31250-6/fulltext?rss=yes

RNA is not Virus

Yonker et al demonstrated high levels of viral RNA in nasopharyngeal samples obtained from children.1

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https://www.jpeds.com/article/S0022-3476(20)31249-X/fulltext?rss=yes

Kawasaki Disease and Clinical Outcome Disparities among Black Children

ICD codes were used to identify children with Kawasaki disease admitted to a tertiary Southeast U.S. center. Subjects diagnosed and treated according to AHA criteria were included. Demographic, laboratory, clinical and echocardiographic data from EMR (2000-2015) were compared between Blacks and Whites.

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https://www.jpeds.com/article/S0022-3476(20)31244-0/fulltext?rss=yes

Routine Early Antibiotic Use in SymptOmatic Preterm Neonates (REASON): A Pilot Randomized Controlled Trial

Antibiotics are routinely used in symptomatic preterm infants after birth for presumed early onset sepsis without clear evidence to guide this practice. Observational studies support an association between routine early antibiotic use in preterm infants and increased risk for morbidities.(1-4) Despite concerns for these morbidities and data showing low rates of culture-confirmed early onset sepsis, most preterm infants are treated with antibiotics in the first days after birth as a standard of care.(5, 6, 7) This practice is based on the hypothesis that preterm deliveries may be precipitated by an infection and that it may be difficult to distinguish between symptoms such as respiratory distress related to prematurity and early onset sepsis.

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https://www.jpeds.com/article/S0022-3476(20)31248-8/fulltext?rss=yes

Reply

We appreciate the important questions raised by Vignesh et al regarding the use of tocilizumab in patients with MIS-C and the follow up of coronary abnormalities. Our study was a multi-institutional observational study without any intervention in medical management. Treatment and supportive therapies were based on institutional protocols and medical team clinical judgment. Various treatment modalities were used by different centers. Intravenous immunoglobulin (IVIG) was used in 54% of patients, corticosteroids in 51%, and IL-1 receptor antagonist (Anakinra) in 12%.

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Use of tocilizumab in multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2

Kaushik et al provide a comprehensive overview of characteristics of the multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (1) All 33 children had evidence of SARS-CoV-2 infection in the form of positive reverse-transcription polymerase chain reaction and/or positive antibody test (1). Similar to routine (non-SARS-CoV-2 related) Kawasaki disease , the commonest treatment modality employed was intravenous immunoglobulin (IVIg).

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