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Cefiderocol Red Wine Urine Syndrome in Pediatric Patients: A Multicenter Case Series

Shapiro, Kate; Ungar, Stephanie P; Krugman, Jessica; McGarrity, Orlagh; Cross, Shane J; Indrakumar, Bairavi; Hatcher, James; Ratner, Adam J; Wolf, Joshua
Cefiderocol is a novel cephalosporin antibiotic with activity against multidrug-resistant gram-negative bacteria and limited pediatric experience. This case series describes 3 immunocompromised children receiving blood transfusion who developed benign red or purple urine with administration of cefiderocol. Interaction with iron from blood products is a possible mechanism. It is important to recognize this phenomenon and distinguish it from hematuria to avoid unnecessary diagnostic testing.
PMID: 37922468
ISSN: 1532-0987
CID: 5607072

Mpox in Children: 3 Cases

Frantzis, Irene; Ungar, Stephanie P; Soma, Vijaya L; Knutsen, Dorothy; Mazo, Dana; Zucker, Jason
Although the 2022 mpox outbreak mostly affected adults, its effect on children and adolescents was also substantial. In this report, we describe the clinical course and treatment of the first 3 known cases of mpox in children in New York City. These cases are instructive because they illustrate various routes of transmission, clinical presentations, and diagnostic challenges that differ from previous reports of mpox in endemic countries and previous mpox outbreaks. Of note is that each of the 3 patients received treatment with tecovirimat under an US Food and Drug Administration expanded access investigational new drug application and improved without exhibiting adverse reactions.
PMID: 38239109
ISSN: 1098-4275
CID: 5627642

Hospital and ICU Admission Risk Associated With Comorbidities Among Children With COVID-19 Ancestral Strains

Ungar, Stephanie P; Solomon, Sadie; Stachel, Anna; Shust, Gail F; Clouser, Katharine N; Bhavsar, Sejal M; Lighter, Jennifer
A large proportion of children have been affected by COVID-19; we evaluated the association between comorbidities and hospitalization/ICU (intensive care unit) admission among 4097 children under age 21 years with symptomatic COVID-19 (not just polymerase chain reaction [PCR]-positive or multisystem inflammatory syndrome in children associated with COVID-19 [MIS-C]) from 2 large health systems from March 2020 to September 2021. Significant comorbidities and demographic factors identified by univariable analysis were included in a multivariable logistic regression compared with children ages 6 to 11 without comorbidities. In all, 475 children (11.6%) were hospitalized, of whom 25.5% required ICU admission. Children under 1 year had high hospitalization risk, but low risk of ICU admission. Presence of at least 1 comorbidity was associated with hospitalization and ICU admission (odds ratio [OR] > 4). Asthma, obesity, chronic kidney disease, sickle cell disease, bone marrow transplantation, and neurologic disorders were associated with hospitalization (adjusted odds ratio [AOR] > 2). Malignancy, intellectual disability, and prematurity were associated with ICU admission (AOR > 4). Comorbidities are significantly associated with hospitalization/ICU admission among children with COVID-19.
PMID: 36661087
ISSN: 1938-2707
CID: 5419282

COVID, monkeypox, polio...oh my! The real risks of infection for your child [Newspaper Article]

Lighter, Jennifer; Ungar, Stephanie
ISSN: 2692-1251
CID: 5477402

Do Not Forget About the Ticks: An Unusual Cause of Fever, GI Distress, and Cytopenias in a Child With ALL

Ungar, Stephanie P; Varkey, Joyce; Pierro, Joanna; Raetz, Elizabeth; Ratner, Adam J
We report the case of a 5-year-old male with B-cell acute lymphoblastic leukemia in remission, receiving maintenance chemotherapy, who presented with fever, emesis, diarrhea, headache, and lethargy. He developed rapidly progressive cytopenias and was found to have acute human granulocytic anaplasmosis as well as evidence of past infection with Babesia microti. The case highlights the need to maintain a broad differential for infection in children undergoing chemotherapy or other immunosuppressive therapies with possible or known tick exposure.
PMID: 34935737
ISSN: 1536-3678
CID: 5108892

HIV Pre-Exposure Prophylaxis: What Do Pediatricians Need to Know?

Ungar, Stephanie P; Paret, Michal; Shust, Gail F
Pediatricians and adolescent providers play an important role in the health and well-being of adolescents and young adults, including their sexual health. HIV remains an ongoing concern for young people, with 21% of new HIV diagnoses occurring in this age group. The use of antiretroviral therapy for pre-exposure prophylaxis (PrEP) to prevent transmission of HIV to people who are not infected has been proven safe and effective. PrEP can be considered as part of a comprehensive risk mitigation strategy for adolescents and young adults, with clear guidelines for baseline evaluation and ongoing management. [Pediatr Ann. 2022;51(5):e191-e195.].
PMID: 35575536
ISSN: 1938-2359
CID: 5468942

Why children are far less at risk from COVID: An explainer [Newspaper Article]

Lighter, Jennifer; Ungar, Stephanie
ISSN: 2692-1251
CID: 5477392

Impact of Prenatal SARS-CoV-2 Infection on Infant Emergency Department Visits and Hospitalization

Ungar, Stephanie P; Solomon, Sadie; Stachel, Anna; Demarco, Kathleen; Roman, Ashley S; Lighter, Jennifer
To better understand the impact of prenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on infants, this study sought to compare the risk of hospital visits and of postnatal SARS-CoV-2 infection between infants born to mothers with and without prenatal SARS-CoV-2 infection. In this retrospective observational cohort study of 6871 mothers and their infants, overall rates of emergency department (ED) visits and hospital admissions in the first 90 days of life were similar for infants born to mothers with and without prenatal SARS-CoV-2 infection. Infants born to negative mothers were more likely than infants of positive mothers to be hospitalized after ED visit (relative risk: 3.76; 95% confidence interval: 1.27-11.13, P = .003). Five infants tested positive; all were born to negative mothers, suggesting that maternal prenatal SARS-CoV-2 infection may protect infants from postnatal infection. The lower acuity ED visits for infants born to mothers with prenatal SARS-CoV-2 infection may reflect a heightened level of concern among these mothers.
PMID: 34903074
ISSN: 1938-2707
CID: 5080812

50 Years Ago in TheJournalofPediatrics: Same Bug, Different Drugs: The Persistent Threat of Escherichia coli Neonatal Sepsis

Popofsky, Stephanie; Pellett Madan, Rebecca
PMID: 34030838
ISSN: 1097-6833
CID: 4887632

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