We read with great interest the recent article by Yeoh et al, demonstrating an altered stool microbiome composition in patients with COVID-19 compared with controls, with greater dysbiosis correlating with elevated inflammatory markers. 1 Additionally, dysbiosis was seen after disease resolution. 1 To our knowledge, gut microbiome studies in young children with COVID-19 have not been reported. Critically, the developing gut microbiome of very young children differs from adults and establishes immune and inflammatory pathways. 2 3 Moreover, children with COVID-19 can subsequently develop autoimmune and autoinflammatory diseases including Multisystem Inflammatory Syndrome in Children (MIS-C) 4 5 , which may in part be microbiome mediated, given recent findings by Yeoh et al. 1 It is difficult to study this in young children, as many with SARS-CoV-2 infection are asymptomatic and rarely tested. 6 To address this, knowing that SARS-CoV-2 can be detected in stool, 7 we used an established study collecting longitudinal stool samples from before and throughout the pandemic to investigate the prevalence and associated microbiome changes of SARS-CoV-2 in very young children. We ran the CDC 2019-Novel Coronavirus Real-Time RT-PCR Diagnostic Panel assay on 769 serial stool samples from 595 children aged 0-24 months collected from February 2020 to February 2021. The prevalence of SARS-CoV-2 in faeces was 1.7% (13 samples from 13 separate children) with prevalence at <2 days and 2, 6, 12 and 24 months of 0% (0/1), 0% (0/21), 2.6% (4/156), 2.0% (7/357) and 0.9%,(2/234), respectively. Prevalence by month is shown in online supplemental figure 1A, with the first positive sample detected 31 days before the first reported case of COVID-19 regionally. No samples were positive in controls collected prior to the pandemic in 2019 (n=97 samples from 66 individuals). Of 13 positive children, 12 were asymptomatic with no personal or family history of SARS-CoV-2 (table 1A). Of 13 children, 1 was symptomatic with COVID-19 diagnosed 21 days before stool was collected. Hispanic ethnicity
Purpose of reviewStudying the outcomes of congenital heart disease and their associations allows paediatric cardiologists and intensivists to improve the care and health equity of their patients. This review presents the most recent literature discussing the socioeconomic and racial disparities that pervade the outcomes of patients with congenital heart disease in every facet of treatment. The outcomes of congenital heart disease discussed are prenatal detection, maintenance of care, quality of life, neurodevelopment and mortality. Recent findingsHistorically, it has been documented that patients with congenital heart disease who are of racial and ethnic minorities disproportionately experience poor outcomes. Recently, the association between racial minorities and mortality has been traced to underlying socioeconomic disparities emphasizing that race and ethnicity are not independent determinants of health.
Introduction:Arrhythmias in the neonatal period are common and can be classi ed as bradyarhythmias and tachyarrhythmias and as benign or non-benign. Neonatal arrhythmias are further differentiated between those with abnormalities in generation (non-sinus) and those with abnormalities in propagation. Because the neonatal myocardium is immature and operates at the peak of the Starling curve, signi cant changes in heart rate can result in a decline in cardiac output and compromise end-organ perfusion. This is especially true for premature neonates, those critically ill, or those with concomitant congenital heart disease. While sustained arrhythmias are frequently witnessed and recorded in tertiary neonatal intensive care units (NICU) very little data exists on the observance of non-sustained brady or tachyarrhythmias in this cohort. No prospective study has been performed on all neonates admitted to a large tertiary NICU throughout their entire stay. The purpose of this study was to prospectively evaluate the prevalence and type of arrhythmias in a large NICU population from admission to discharge. Methods:All neonates admitted to the NICU at Inova Children's Hospital at Inova Fairfax Medical Campus between January 1, 2021 and April 1, 2021 were prospectively evaluated from admission to hospital discharge via continuous bedside monitoring reviewed every 24 hours. Concerning telemetry strips were reviewed by two team members as well as the senior electrophysiologist. Results:Two-hundred and one neonates (mean gestational age = 34 4/7 weeks') were enrolled in the study.Admission length ranged from 1 to 195 days (total of 5624 patient days, median 16 days). Overall, 68% (N = 137) of admissions had one or more arrhythmias, the most common of which was sinus tachycardia (65%, N = 130), followed by sinus bradycardia (30%, N = 60). Clinically relevant arrhythmias were diagnosed in 6.5% of neonates. During the study period there were four deaths, none of which were directly attributable to a primary arrhythmia. Conclusion:Approximately 68% of neonates exhibited at least one arrhythmia. Although the vast majority of these arrhythmias were benign, clinically relevant arrhythmias were observed in 6.5%. Patients admitted to the NICU appear to have a relatively high burden of benign arrhythmias, but a relatively low burden of pathologic arrhythmias.
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