Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and endoscopic ultrasound with an echobronchoscope‐guided fine needle aspiration (EUS‐B‐FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. Objective To describe the utility and safety of EBUS‐TBNA and EUS‐B‐FNA in children with mediastinal pathologies of unknown etiology. Design Chart review. Setting Pediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018. Patients Children <18 years of age with mediastinal pathologies of undefined etiology. Methods Case records of children who underwent EBUS‐TBNA and EUS‐B‐FNA were reviewed. Data on demographic profile, clinical features, laboratory investigations, the technique of EBUS‐TBNA/ EUS –B‐ FNA, complications, and findings were collected. Results Thirty children (19 males) with mean (SD) age of 9.6 (±3.5) years underwent endobronchial procedures. Median (IQR) weight(kg) and height(cm) were 29 (19.5, 35) and 134 (125, 150) respectively. Tuberculosis was the most common preprocedure clinical diagnosis (73.3%), followed by lymphoma (13.3%). Presenting features were fever (80%), cough (53.3%), hepatomegaly (13%), peripheral lymphadenopathy (21.7%), and positive tuberculin skin test (63.3%). Approximately one fourth were on antitubercular therapy without definite evidence of TB. Conscious sedation was used for the procedures: midazolam and fentanyl (n = 22), propofol (n = 8). Transesophageal, transtracheal, and both routes were used in 20 (66.6%), 7 (23.3%), and 3 (10.1%), respectively. Lymph‐nodes were sampled in 24 children (subcarinal in 16, right paratracheal in 4 and both in 4). Mean (SD) size of lymph node (in cm) on EBUS was 1.93(±0.5) and median (IQR) number of FNAC needle passes per node were 2 (2, 4). The diagnosis was confirmed in 11 (36.6%, tuberculosis in 10 by GeneXpert/ MGIT/ cytopath and lymphoma in one) patients. Only 3.3% had a minor complication. Conclusion EBUS‐TBNA and EUS‐B‐FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.

Objectives To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic. Methods This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included. Results Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d. Conclusions In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.

The illness severity scoring systems provide objective measures for inter- and intra-unit comparisons with time and also provide useful information for comparing the severity of illness of patients, at the time of enrollment into clinical trials. These scores are an essential part of the improvement in clinical decisions and in stratifying patients with poor outcomes. Appropriate application of these models helps in decision-making at the right time and in decreasing mortality. However, it is also important to note that the choice of illness scores should accurately match the setting in which they are designed. In Indian setting, there is no Pediatric Intensive Care Unit illness severity score is designed until now as per our patient profile and resources. The purpose of this review article is to provide an idea regarding the evolution of illness severity scores in developed countries till date along with their utility. This review emphasizes the need for the development of pediatric illness severity score as per the local resources.

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Introduction There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India. Methods In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations, and outcome. Results We included 402 children with a median (IQR) age of 7 (2,11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%; thrombocytopenia 22.1%; transaminitis 26.4%; low total serum protein 34.7%; low serum albumin 37.9%; and, and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95); c-reactive protein 33.3% (41/123); procalcitonin 53.5% (46/86); and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein, and raised c-reactive protein were factors associated with moderate to severe disease. Conclusion Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin, and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.

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BackgroundFew single center studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-center studies on the same is lacking including from Indian setting.MethodsThis retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤ 15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was mortality.ResultsA total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 50.7% and 39.6% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Fifteen (11.2%) children died. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (&gt;300 U/L), and hypoalbuminemia were the factors significantly associated an increased mortality.ConclusionsMIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (&gt;300 U/L), and hypoalbuminemia were associated with an increased mortality. No difference in outcome was noted with either steroid or IVIg or both. Coronary artery abnormalities resolved in nearly all cases.