Background: Lockdown is an effective nonpharmaceutical intervention to reduce coronavirus disease 2019 (COVID-19) transmission, but it restricts daily activity. We aimed to investigate the impact of lockdown on pediatric body weight and body mass index (BMI). Methods: The systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Four online databases (EMBASE, Medline, the Cochrane Library and CINAHL) were searched. Results: The pooled results showed that lockdown was associated with significant body weight gain (MD 2.67, 95% CI 2.12–3.23; p < 0.00001). The BMI of children with comorbidities or obesity did not change significantly. The BMI of general population was significantly higher during lockdown than before the pandemic (MD 0.94, 95% CI 0.32–1.56; p = 0.003). However, heterogeneity was high (I2 = 84%). Among changes in weight classification, increases in the rates of obesity (OR 1.23, 95% CI 1.10–1.37; p = 0.0002) and overweight (OR 1.17, 95% CI 1.06–1.29; p = 0.001) were reported. Conclusions: Our meta-analysis showed significant increases in body weight and BMI during lockdown among school-age children and adolescents. The prevalence of obesity and overweight also increased. The COVID-19 pandemic worsened the burden of childhood obesity.

M ycoplasma pneumoniae is a common causative pathogen in community-acquired pneumonia (CAP) during childhood. In the post-pneumococcal conjugate vaccine (PCV) 13 era, the epidemiology of pediatric pneumonia has changed. In some countries where PCV13 is already included in national immunization program, M. pneumoniae has become the leading pathogen in pediatric CAP (1,2).The clinical manifestations of M. pneumoniae infection are usually mild and self-limited. However, life-threatening pneumonia or even acute respiratory distress syndrome requiring extracorporeal membrane oxygen has been reported (3). Furthermore, some extrapulmonary symptoms, such as mucositis, hepatitis, encephalitis, hemolysis, or erythema multiforme, have linked M. pneumoniae infection to the formation of autoimmunity or immune complexes. The association between M. pneumoniae and refractory asthma has also been mentioned (4).Macrolides are the first-line therapy for M. pneumoniae. Because of high oral bioavailability and oncedaily formulation, macrolides have been widely used in outpatient settings. During the past 10 years, however, macrolide-resistant Mycoplasma pneumoniae (MRMP) has emerged worldwide. The most prevalent area is Asia, where prevalence rates are 13.6%-100% (5). In Japan and China, resistance rates are >90% in some epidemic years (5,6).The treatment of MRMP has become challenging. Although 1 report showed more complications in managing MRMP infections (7), the association between severe disease and resistance remains inconsistent and unclear. We conducted a systematic review and meta-analysis to examine the effect of macrolide resistance on the manifestations, outcomes, and clinical judgment of M. pneumoniae infection. Methods Search StrategyWe conducted a systematic literature search in PubMed, Embase, and the Cochrane Library database using the keywords Mycoplasma pneumoniae, macrolide, antibiotic resistance, and drug resistance. There was no language restriction in our search. We reviewed eligible full texts and the reference lists of the relevant studies. The last update of the study was on December 1, 2019.Two independent reviewers (Y.-C.C. and T.-H.C.) screened all titles and abstracts for eligibility. Studies were eligible for inclusion if the study population was restricted to children (<18 years of age) with community-acquired pneumonia; macrolide

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Rationale:Unlike other enteroviruses which can cause herpangina or hand-foot-and-mouth disease, enterovirus D68 (EV-D68) has usually been linked to respiratory and neurological problems in young children. Skin manifestations had rarely been described in current literatures.Patient concerns:We report a 17-year-old girl with fever and painful skin rash over legs and soles for 9 days. Pitting edema was also noted below the knees. There was no respiratory tract or neurological symptoms in this patient.Diagnoses:EV-D68 was detected from a throat swab by RT-PCR and confirmed to be subclade B3 by sequencing.Interventions:Supportive management.Outcomes:The patient was afebrile after 9 days and got full recovery on the 23rd day at outpatient follow-up.Lessons:To the best of our knowledge, this is the first report of EV-D68 infection with skin manifestations, clinical images, and detailed clinical course. Our findings in this particular case extend the understanding of the disease spectrum.

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