After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international cooperation , this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.

Introduction: Diagnostic criteria for acute lung injury (ALI) and Acute Respiratory Distress syndrome (ARDS) includes acute onset of disease, chest radiograph demonstrating bilateral pulmonary infiltrates, lack of significant left ventricular dysfunction and Pao2/Fio2 (PF) ratio ≤300 for ALI or ≤200 for ARDS. Recent criteria require invasive arterial sampling. The pulse oximetric saturation Spo2/Fio2 (SF) ratio may be a reliable non-invasive alternative to the PF ratio. Methods: In this cross-sectional study, we enrolled 70 patients with ALI or ARDS who were admitted in Tabriz children’s hospital pediatrics intensive care unit (PICU). Spo2, Fio2, Pao2, charted within 5 minutes of each other and calculated SF and PF were recorded to determine the relationship between SF and PF ratio. SF values were examined as a substitute of PF ratio for diagnosis ARDS and ALI. Results: The relationship between SF and PF ratio was described by the following regression equation: SF=57+0.61 PF (P<0.001). SF ratios of 181 and 235 corresponded of PF ratio 300 and 200. The SF cutoff of 235 had 57% sensitivity and 100% specificity for diagnosis of ALI. The SF cutoff of 181 had 71% sensitivity and 82% specificity for diagnosis of ARDS. Conclusion: SF ratio is a reliable noninvasive surrogate for PF ratio to identify children with ALI or ARDS with the advantage of replacing invasive arterial blood sampling by non-invasive pulse oximetry.

This study aimed at evaluating the mortality rate in a PICU applying PRISM-III. Two hundred and twenty one infants and children consecutively admitted to PICU of Tabriz Children's Hospital were studied during a 13 months period of time. Data required for calculating the PRISM-III score were collected during the first 24 h of PICU stay in all patients. The prediction of actual mortality by PRISM-III scoring was evaluated by the Hosmer and Lemeshow goodness-of-fit test. Receiver Operating Characteristic (ROC) curve was constructed, as well. The observed (O) short-term (during hospital stay) mortality rate was compared with the expected (E) figures as the O/E ratio. The mean value of the PRISM-III score was 14.22 +/- 9.57(2-42). ROC analysis indicated a strong predictive power for the PRISM-III (area under the curve = 0.898) and the test was well fit to the designed study (goodness-of-fit p-value = 0.161). The observed short-term mortality rate was 9.05% and the expected mortality rate by the PRISM-III scoring was 9% (O/E ratio = 1.005). The PRISM-III scoring system was highly calibrated in our institute.

VBG can be used instead of ABG in some diseases such as respiratory distress syndrome, neonatal sepsis, renal failure, pneumonia, diabetic ketoacidosis and status epilepticus, but in other diseases such as neonatal seizure, shock, congestive heart failure and congenital heart diseases, ABG is preferable and must not be replaced by VBG. These results may be used for the formulation of future guidelines for PICU.

The lack of high quality RCTs makes it impossible to support a general recommendation about the use of probiotics in the treatment of CF pulmonary exacerbation and intestinal inflammation.