Objective: We aimed to describe the presentations and biochemical characteristics of sepsis-like syndrome (SLS) in infants aged <2 months who tested positive for SARS-CoV-2-in comparison to those in the same age group who were SARS-CoV-2-negative.Background: COVID-19 presents with a spectrum of manifestations, and children seem to have a favorable clinical course compared to other age groups. Limited data are available for symptomatic infants.Design: This was a case-controlled single-institution retrospective study on infants aged <2 months admitted with SLS between 1 April 2020 and 1 July 2020. These infants were divided into 2 groups: Group 1 (n = 41), infants with positive nasal/oropharyngeal swab polymerase chain reaction (PCR) results for SARS-CoV-2; and Group 2 (n = 40), infants with negative PCR results for SARS-CoV-2 (control group). Details between both groups were reviewed and analyzed.Outcome: The clinical and laboratory data for SARS-CoV-2 -positive infants who presented with SLS may differ from those for infants with SLS who tested negative for SARS-CoV-2.Results: Overall, 105 infants were admitted with clinical sepsis: 41 were SARS-CoV-2-positive, and 64 were negative. Fever was present in 90% of SARS-CoV-2-positive infants vs. 80% of the negative group. SARS-CoV-2-positive infants had a higher incidence of nasal congestion and cough (39 and 29%, respectively) compared to the SARS-CoV-2-negative group (20 and 3%, respectively) (P < 0.05). Poor feeding and hypoactivity occurred more frequently in the SARS-CoV-2-negative group (58 and 45%, respectively) than in the SARS-CoV-2-positive group (22 and 12%, respectively, P < 0.004). Sepsis workup, including lumbar puncture, was performed in 67% and partial septic workup was performed in 23% of the SARS-CoV-2-positive infants. Full sepsis workup was performed in 92% of the SARS-CoV-2-negative group. Cerebrospinal fluid (CSF) cultures were negative in 26/27SARS-CoV-2-positive infants (an infant had Klebsiella meningitis). All the SARS-CoV-2-negative infants had negative CSF cultures. Blood culture was negative in both groups. Urine culture showed bacterial growth in 9 infants with SARS-CoV-2-negative sepsis.Conclusions: Our study showed that respiratory symptoms (cough and nasal congestion) were more prominent in the SARS-CoV-2-positive group, while poor feeding and hypoactivity were reported more frequently in the negative group. However, the clinical differentiation between COVID-19 disease and sepsis in such age groups is difficult. Therefore, screening young infants with SLS for SARS-CoV-2- is necessary during this pandemic.

Background: World Health Organization (WHO) and other Health officials alert clinicians about a rare but severe inflammatory condition seen in children and linked to Corona Virus Disease 2019(COVID-19). The WHO is describing the condition as a multisystem inflammatory syndrome in children (MIS-C) and is recommending clinicians to report those cases to get a better understanding of the disease and clinicians can learn more.Case presentation: We are reporting the clinical course of the youngest case of COVID-19 related MIS-c; a two-week-old term neonate with COVID-19 infection and features suggestive of MIS-C , managed with intravenous immunoglobulin (IVIG), pulse steroid, and interleukin-1 inhibitor (Anakinra).By reviewing the literature, our baby is the first neonatal case who has been diagnosed with MIS-C.Conclusion: COVID-19 infection in pediatrics are likely to present with a mild course; however, some may develop a hyper-inflammatory syndrome. Pediatricians should be aware of such presentation, the clinical course, the management modalities, and inform parents and caregivers about common signs and symptoms. Anakinra may consider as effective second agent in (IVIG and steroid-refractory pediatric cases).

Background Cerebral Palsy (CP) is the most common paediatric condition with spasticity. The prevalence of CP in the UK is 186/100000. NICE recommends that all children and young people (CYP) with spasticity be referred to a network of team and assessed by a physiotherapist and or occupational therapist. We should offer a therapy programme tailored to the CYP's individual needs aimed at specific goals such as enhancing skills, function, participation and preventing complications.Botulinum toxin (BoNT) is offered for focal spasticity if it is impeding function, compromising hygiene, causing pain, impeding tolerance of other treatment and causing cosmetic concerns to CYP. A careful assessment of baseline muscle tone, range of movements and function against response to treatment is undertaken before injection, 6-12 weeks and 12-26 weeks after injections. Aim To review whether spasticity management programme is individualised, goal focussed and NICE compliant. To assess use of BoNT, monitor CYP's response to treatment and development of complications. Methods Retrospective review of notes of all patients who received BoNT treatment within our spasticity service between 2012-'15. 59 patients were assessed in spasticity clinic during this period and 19 qualified and recieved BoNT treatment. Results Cerebral palsy was the aetiology in 84% and stroke in 11% in the treated group. One third had severely affected motor skills (GMFCS IV/V). Majority were injected for impeding motor function (84%). Other reasons include compromised care (40%), pain (20%), and cosmesis (8%). Upper limb was injected in 32%, lower limb in 52%, and both in 16%. Physiotherapist was involved in the assessments in all cases. Consent was obtained in all. Information leaflets were provided in 95% of patients. There were no complications. 89% of patients achieved their treatment goals. In 47% treatment goals were exceeded. Overall improvement was noted in 84%.Further interventions undertaken after BoNT treatment include selective Dorsal Rhizotomy (5%), Multilevel surgery (21%), Intrathecal Baclofen (5%), Gait analysis (26%). Conclusion Majority of BoNT treated patients had spastic CP. Improvement of motor function was the main goal for treatment. There were no complications. 89% achieved their treatment goals and 84% reported overall improvement, both in their motor function and general well-being.

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