Faculty Bibliography

Since the initial identification of respiratory syncytial virus (RSV) in 1956, much has been learned about the epidemiological impact and clinical manifestations of RSV infections [...].

There has been a recent increase in the incidence of urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, which are resistant to third-generation cephalosporins. Our goal was to compare the clinical responses of patients with ESBL UTI and non-ESBL UTI who received empiric third-generation cephalosporins. A retrospective analysis was performed on data collected between June 1, 2013, and June 30, 2017, from children aged 0 days to 19 years old who presented to NYU Langone Long Island Hospital's pediatric ED and/or were admitted with a UTI caused by Enterobacteriaceae. There was no significant difference in median length of fever duration. However, ESBL patients had significantly longer hospital stays, higher 30-day readmission rate, and higher 7-day revisit rate. It is reasonable to maintain an empiric UTI antibiotic choice rather than selecting a broad-spectrum antibiotic, such as carbapenem for children at high risk of ESBL UTI.

Children account for a growing share of coronavirus disease 2019 (COVID-19) infections in the United States. Since the widespread availability of COVID-19 vaccine in adults, there has been an upward trend of cases in children, accounting for approximately 20% of the weekly new cases. The majority (38.3%) reported in high school students age 14 to 17 years. Children are also at risk of a postinflammatory condition, known as multisystem inflammatory syndrome in children, after COVID-19. In addition, infected children could transmit the virus to vulnerable adults, contributing to ongoing pandemic. We believe that children need to be vaccinated against COVID-19 and review the available evidence. [Pediatr Ann. 2022;51(5):e180-e185.].

Influenza A virus (IAV) is a major cause of respiratory infections worldwide, with the most severe cases occurring in the very young and in elderly individuals [...].

Purpose of Study We studied the risk of apnea in otherwise healthy infants < 6 mo based on severity of illness at presentation. We also compared clinical courses between mild and severe disease groups. Methods Used This is a retrospective chart review of infants evaluated in the emergency department (ED) over 3 consecutive RSV seasons: 2017-2018, 2018-2019, and 2019-2020. We included infants < 6 mo with RSV diagnosed using multiplex PCR assay. Infants with history of prematurity ( 37 weeks), past apnea, chronic lung disease, heart disease, airway anomalies, neuromuscular diseases, and genetic disorders were excluded. Clinical data were reviewed to separate patients into mild or severe cases. Infants with respiratory rate (RR) >= 60, retractions, oxygen saturation < 90%, poor oral intake, or dehydration were classified as severe. Summary of Results A total of 161 infants met study criteria: 52 mild and 109 severe. There was no risk of apnea in mild cases and low risk in severe cases. Significant differences included length of stay (LOS), oxygen requirement, ICU admission, and hospital readmission (table 1). About 59% of severe cases required oxygen support, the majority of which received high flow nasal cannula, while 29% of mild cases required support and most were placed on regular nasal cannula (table 2). Twenty-seven severe cases required ICU and LOS was 1 day longer than mild. Forty-two severe cases were readmitted after initial discharge compared to 2 mild cases. Conclusions There was a low incidence of apnea in full term infants < 6 mo with RSV regardless of severity of disease, suggesting that risk of apnea is not a reliable factor when considering hospital admission. Conversely, high RR, retractions, hypoxia on presentation, poor PO intake, and dehydration were specific to severe RSV disease. The differences in oxygen support, ICU admission, and readmission emphasize the importance of identifying mild versus severe RSV to anticipate clinical courses. Further studies are needed to standardize and validate characteristics of RSV that require hospitalization. (Table Presented)

Pediatric patients with "once-daily" fevers are often referred to pediatric infectious disease specialists for evaluation. Often, these fevers occur at nighttime in the absence of additional symptoms and come to the caregiver's attention after a viral illness. It is crucial for caregivers and providers to be able to define and measure fever accurately when trying to ascertain the true etiology of this clinical picture. Fever education is critical in providing reassurance to parents, and fever diaries should be encouraged. In a well-appearing child without any additional symptoms, at least a percentage of these fevers can be explained by normal diurnal variation of temperature. [Pediatr Ann. 2022;51(5):e202-e205.].