Background and aim of the studyThe frequency of new visits for precocious puberty increased during the Covid-19 pandemic in the pediatric endocrinology clinic at Rady Children's Hospital in San Diego, CA, US. A few recent studies have shown an increase in the frequency of Central Precocious Puberty (CPP) in other centers during this pandemic. This study evaluated the change in incidence of new CPP cases requiring treatment with GnRH agonist (GnRHa) at Rady Children's Hospital during the Covid-19 pandemic and compared it to pre-pandemic years.MethodsData were reviewed retrospectively to compare the number of visits of children newly diagnosed with CPP treated with GnRHa during the Covid-19 pandemic (5/2020–4/2021) and before the pandemic (5/2018–4/2019). Clinical and bone maturation data were evaluated as well as differences in timing from diagnosis to onset of treatment. The incidence of CPP requiring treatment for 5 years prior to the pandemic was also reviewed to evaluate for trends over time.ResultsA total of 92 subjects were included. During pre-Covid year, 28 children (1 boy, 27 girls) were treated with GnRHa for CPP out of 2,340 new endocrinology visits (1.2% of patients seen). During Covid-19 year, 64 children (7 boys, 57 girls) were treated out of 2,261 new visits (2.8%). The incidence of new CPP cases requiring GnRHa during the pandemic more than doubled compared to pre-pandemic. Age at onset of treatment, degree of bone age (BA) advancement, time from diagnosis to onset of treatment, and changes in BMI during the pandemic were not different from pre-pandemic.ConclusionCPP cases requiring GnRHa treatment significantly increased during the first year of the Covid-19 pandemic. This was not related to increased BMI or delay in onset of treatment. Age at diagnosis, degree of bone age advancement, and time from diagnosis to onset of treatment were all similar during the first year of the pandemic compared to the prior year.
BACKGROUND: Community-acquired pneumonia (CAP) is common in pediatrics. More severe complicated CAP (cCAP) requires broad-spectrum empirical therapy. Cell-free plasma next-generation sequencing (cfNGS), a DNA-based diagnostic tool, could be used to guide therapy. We retrospectively compared the pathogen identification rate of cfNGS to that of standard culture methods and assessed the impact of cfNGS on antibiotic therapy in children hospitalized for cCAP. METHODS: We conducted a retrospective review of children aged 3 months to 18 years hospitalized for cCAP with cfNGS results from January 24, 2018, to December 31, 2020. We compared the positivity rate of conventional microbiologic diagnostic testing with that of cfNGS and the impact on clinical management, including changes in antibiotic therapy. RESULTS: We identified 46 hospitalized children with cCAP with cfNGS results. Of these children, 34 also had blood cultures (1 positive for pathogen; 3%) and 37 had pleural fluid cultures (10 positive for pathogen; 27%). Of the 46 children, positive cfNGS testing results were positive for pathogen in 45 (98%), with the causative pathogen identified in 41 (89%). cfNGS was the only method for pathogen identification in 32 children (70%). cfNGS results changed management in 36 (78%) of 46 children, with the antibiotic spectrum narrowed in 29 (81%). CONCLUSIONS: cfNGS provided a higher diagnostic yield in our pediatric cCAP cohort compared with conventional diagnostic testing and affected management in 78% of children. Prospective studies are needed to better characterize the clinical outcome, cost-effectiveness, and antimicrobial stewardship benefits of cfNGS in pediatric cCAP.
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