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Diagnosing PFAPA during the COVID-19 era: clarity during quarantine [Letter]

Fiorito, Theresa; Akerman, Meredith; Noor, Asif; Krilov, Leonard R
PMID: 35190384
ISSN: 1468-2044
CID: 5172042

SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation

Paret, Michal; Lalani, Karim; Hedari, Carine; Jaffer, Annum; Narayanan, Nisha; Noor, Asif; Lighter, Jennifer; Madan, Rebecca Pellett; Shust, Gail F; Ratner, Adam J; Raabe, Vanessa N
PMID: 34193619
ISSN: 1098-4275
CID: 4926782

Necrotizing Fasciitis [Editorial]

Noor, Asif; Krilov, Leonard R
PMID: 34599059
ISSN: 1526-3347
CID: 5173922

Seasonal variation of respiratory viral infections: a comparative study between children with cancer undergoing chemotherapy and children without cancer

Dror, Tal; Akerman, Meredith; Noor, Asif; Weinblatt, Mark E; Islam, Shahidul; Glasser, Chana L
Respiratory viral infections (RVIs) affect children year-round, with seasonal-specific patterns. Pediatric oncology patients are uniquely vulnerable to infection, but whether this predisposes them to different patterns of RVIs than healthy children is unknown. There is also limited data on the impact of RVIs on cancer patients. We conducted a retrospective study of children ages 1-21 with cancer presenting to the clinic and emergency department (ED) and a randomly selected subset of patients without cancer presenting to the ED who had positive nasopharyngeal viral polymerase chain reactions at our institution from 2014 to 2019. Sixty-seven cancer patients (206 RVI episodes) and 225 pediatric non-cancer patients (237 RVI episodes) were included. Human rhino/enterovirus (HRE) was the most common infection in both groups in the spring, summer, and fall. In the winter, the most common RVI was influenza in cancer patients verses respiratory syncytial virus in non-cancer patients. On age-adjusted analysis, the likelihood of detecting coronavirus in the winter, HRE in the spring and fall, and parainfluenza in the summer was significantly greater in cancer patients (OR = 2.60, 2.52, 5.73, 3.59 respectively). Among cancer RVI episodes, 50% received parenteral antibiotics, 22% were severely neutropenic, 22% had chemotherapy delays for a median of six days, 16% were hospitalized, and 6% received intravenous immunoglobulin. We conclude that there are differences in the seasonal patterns of RVIs between children with and without cancer. RVIs also cause significant morbidity in children with cancer.
PMID: 33792490
ISSN: 1521-0669
CID: 4830992

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Young, Trevor K; Shaw, Katharina S; Shah, Jinal K; Noor, Asif; Alperin, Risa A; Ratner, Adam J; Orlow, Seth J; Betensky, Rebecca A; Shust, Gail F; Kahn, Philip J; Oza, Vikash S
Importance/UNASSIGNED:To date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms. Objective/UNASSIGNED:To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020. Design, Setting, and Participants/UNASSIGNED:A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C. Main Outcomes and Measures/UNASSIGNED:Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists. Results/UNASSIGNED:Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity. Conclusions and Relevance/UNASSIGNED:In this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.
PMID: 33295957
ISSN: 2168-6084
CID: 4708992

An Overview of the Ongoing Clinical Issues of COVID-19

Noor, Asif; Krilov, Leonard R
Childhood cases of coronavirus disease 2019 (COVID-19) are on the rise as the pandemic continues to rage across the globe. Most children acquire infection from an adult household member. Children may stay asymptomatic, have a pre-symptomatic stage, or present with symptoms (fever, cough, and difficulty breathing being the most common). Nearly one-third of the pediatric cases (32%) in the United States occurred in children age 15 to 17 years. Children are also at risk of a postinfectious hyperinflammatory syndrome called multisystem inflammatory syndrome in children (MIS-C). The risk of vertical transmission is low (2%) in newborns of mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nucleic acid amplification testing (NAAT) is the gold standard for (SARS-CoV-2). Serology should be considered in a child with high clinical suspicion for COVID-19 when NAAT is negative and at least 2 weeks have passed since symptom onset and for assessment of MIS-C. Easy fatigability after COVID-19 infection is reported in adults; however, data in children are lacking. Implementation of early and robust containment strategies coupled with universal COVID-19 vaccination are vital to halt the spread. [Pediatr Ann. 2021;50(2):e84-e89.].
PMID: 33576834
ISSN: 1938-2359
CID: 4780192

Characteristics of Hospitalized Children With SARS-CoV-2 in the New York City Metropolitan Area

Verma, Sourabh; Lumba, Rishi; Dapul, Heda M; Simson, Gabrielle Gold-von; Phoon, Colin K; Phil, M; Lighter, Jennifer L; Farkas, Jonathan S; Vinci, Alexandra; Noor, Asif; Raabe, Vanessa N; Rhee, David; Rigaud, Mona; Mally, Pradeep V; Randis, Tara M; Dreyer, Benard; Ratner, Adam J; Manno, Catherine S; Chopra, Arun
PMID: 33033078
ISSN: 2154-1671
CID: 4627202

Impact of Maternal SARS-CoV-2 Detection on Breastfeeding Due to Infant Separation at Birth

Popofsky, Stephanie; Noor, Asif; Leavens-Maurer, Jill; Quintos-Alagheband, Maria Lyn; Mock, Ann; Vinci, Alexandra; Magri, Eileen; Akerman, Meredith; Noyola, Estela; Rigaud, Mona; Pak, Billy; Lighter, Jennifer; Ratner, Adam J; Hanna, Nazeeh; Krilov, Leonard
OBJECTIVE:To assess the impact of separation of SARS-CoV-2 PCR-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN/METHODS:This is an observational longitudinal cohort study of SARS-CoV-2 PCR-positive mothers and their infants at three NYU Langone Health hospitals from March 25, 2020 through May 30, 2020. Mothers were surveyed by telephone regarding pre-delivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to COVID-19. RESULTS:Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. No significant difference was observed in pre-delivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads in the hospital (p<0.001), and at home (p=0.012). Only two mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change among the separated compared with the unseparated group (49.0% vs 16.7%, p<0.001). When dyads were further stratified by symptom status into four groups (asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated), results remained unchanged. CONCLUSION/CONCLUSIONS:In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; one case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.
PMID: 32791077
ISSN: 1097-6833
CID: 4556622

Outcomes of Maternal-Newborn Dyads After Maternal SARS-CoV-2

Verma, Sourabh; Bradshaw, Chanda; Auyeung, N S Freda; Lumba, Rishi; Farkas, Jonathan S; Sweeney, Nicole B; Wachtel, Elena V; Bailey, Sean M; Noor, Asif; Kunjumon, Bgee; Cicalese, Erin; Hate, Rahul; Lighter, Jennifer L; Alessi, Samantha; Schweizer, William E; Hanna, Nazeeh; Roman, Ashley S; Dreyer, Benard; Mally, Pradeep V
PMID: 32737153
ISSN: 1098-4275
CID: 4553402

Young Children Presenting With Fever and Rash in the Midst of SARS-CoV-2 Outbreak in New York

Wolfe, Danielle Marissa; Nassar, George Noble; Divya, Kanneganti; Krilov, Leonard R; Noor, Asif
PMID: 32633553
ISSN: 1938-2707
CID: 4518312