Will cases of multisystem inflammatory syndrome rise with the greater spread of the Omicron variant amongst children?A number of variants have influenced global infection rates since COVID-19 was declared a pandemic in March 2020. Italy was the first Western country to be badly affected by the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and we are witnessing clear variations in the ages of infected subjects.Children now account for a higher percentage of people with the virus than they did at the start of the pandemic, and this raises concerns about whether we will see an increase in children with multisystem inflammatory syndrome associated with COVID-19 (MIS-C).Data provided by the Italian National Institute of Health, for the period 11 December 2021 to 11 January 2022, showed that 19.4% of the 2-million new cases of COVID-19 that were reported were patients under the 18 years of age. 1 This was much higher than the data provided by the Ministry of Health for the 6-month period up to 11 January 2022, which showed that 2.71% of the patients affected by COVID-19 were 12-19 years, and 4.65% were aged 5-11 years. 2 This new finding that 1 in 5 cases were paediatric patients also contrasts with the data published by the World Health Organization (WHO) for the first 30 days of the pandemic, which indicated that only 1.6% of the confirmed Italian cases were paediatric patients. 1 BRIEF REPORTWe do not know if MIS-C may be more or less associated with the SARS-CoV-2 Omicron variant. Several studies have been evaluating the risk of MIS-C during different pandemic waves, according to the variants in circulation at the time. However, we do know that the Omicron variant could evade immunity in vaccinated subjects, due to the numerous mutations in the spike protein. 3 If it can do this, we speculate that we could also see an increase in MIS-C cases triggered by the Omicron variant in vaccinated children and adolescents. However, we do not have any data to support this hypothesis at this stage. In addition, we need to bear in mind that only a very small percentage of children under the age of 12 are currently vaccinated and that vaccinations have not been approved for children under the age of 5. We also need to consider the increasingly high rate of children with SARS-CoV-2 infections who are mainly unvaccinated. This, combined with the major circulation of the Omicron variant, could lead to an increase in the incidence of MIS-C. It is very important that paediatricians investigate any history of SARS-CoV-2 infections in patients or family members when children present with fever, a poor general condition and the possible involvement of one or more organs. MIS-C should be considered if all other infections have been excluded. Future prospective studies will be needed to compare MIS-C cases triggered by the Delta and Omicron variants.
Aim: We examined the prevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children during the autumn and winter season from 1 September 2021 to 30 January 2022 and compared it with the same period in 2020-2021. Methods: This study was carried out int the paediatric emergency department (PED) of a tertiary Italian hospital. We compared the clinical and demographical features of all children who presented during the two study periods and tested positive for SARS-CoV-2. Results: During the 2021-2022 autumn and winter season 5813 children presented to the PED, 19.0% were tested for SARS-CoV-2 and 133 (12.0%) of those tested positive. In 2020-2021, 2914 presented to the PED, 12.3% were tested, and 30 (8.3%) of those tested positive. There were no statistically significant differences in clinical severity during the two study periods, despite a higher percentage of neurological symptoms in 2020-2021. Of the SARS-CoV-2-positive cases, 29/133 (21.8%) were hospitalised during the 2021-2022 season and 10/30 (33.3%) during the previous one. Only 3/163 children required intensive care. Conclusion:The greater spread of SARS-CoV-2 was probably due to the greater transmissibility of the Omicron variant, but the symptoms were mild and only 3 children required intensive care.
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0–17 years) evaluated for foreign body ingestion at the Pediatric ED of “Fondazione Policlinico Universitario A. Gemelli, IRCSS” between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays.
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