Cristina Calvo

and 3 more

The prevalence of asthma in children in Europe is an average of 10.3%. The role of asthma as a risk factor for COVID-19 in children is unknown. Our aim was to study the prevalence of asthma in children with SARS-CoV-2 infection and to compare them in hospitalized children and those with mild ambulatory symptoms. We conducted an observational retrospective study in 99 children (between 3- 17 years of age) with a confirmed SARS-CoV-2 infection between March and December 2020. The existence of a history of asthma was investigated using the validated ISAAC questionnaire and clinical data on COVID-19 were compiled. The median age was 10 years (IQR=13-5), and 60/99 (60.6%) patients had mild infections controlled as outpatient, while 39/99 (39.4%) required admission. The prevalence of asthma ─affirmative response to question 6 of the ISAAC questionnaire─ was 11.1% (11/99). The prevalence of asthma in children who required admission increased to 17.9% and to 21.4% in patients requiring PICU, while in outpatients children was 6.7% (p=0.079). We found a significant association between the use of salbutamol during the last year and the need for admission (23.1% in hospitalized patients vs 3.3% in outpatients; OR= 8.7, 95%CI 1.7-42.8). Likewise, budesonide treatment in the last year (17.9% vs 1.7%, OR= 12.9, 95%CI 1.5-109.5) was also a risk factor for admission. Therefore, a history of asthma was not a risk factor for SARS-CoV-2 infection in our series, but active asthma could be a risk factor for severity and need for hospitalization for COVID-19 in children

Rut del Valle Pérez

and 28 more

Pneumonia is a frequent manifestation of COVID-19 in hospitalized children. Methods The study involved 80 hospitals in the SARS-CoV-2 Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from 2012 to 2019. Results In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP included. Main clinical features of SARS-CoV-2-associated CAP were cough 117/151(77%), fever 115/151(76%) and dyspnea 63/151(46%); 22/151(15%) patients were admitted to a pediatric intensive care unit (PICU), and 5/151(3%) patients died. Lymphopenia was found in 63/147(43%) patients. Chest X-ray revealed condensation (64/151[42%]) and other infiltrates (87/151[58%]). Compared with CAP from other viral pathogens, COVID-19 patients were older (8 vs.1 year; odds ratio [OR] 1.42 [95% confidence interval, CI 1.23;1.42]), with lower CRP levels (23 vs.48 mg/L; OR 1 [95%CI 0.99;1]), less wheezing (17 vs.53%; OR 0.18 [95%CI 0.11;0.31]) and greater need of mechanical ventilation, MV (7 vs.0.7%, OR 10.8 [95%CI 1.3;85). Patients with non-SARS-CoV-2-associated CAP had a greater need for oxygen therapy (77 vs.44%, OR 0.24 [95%CI 0.14;0.40]). There were no differences in the use of CPAP or HVF or PICU admission between groups. Conclusion SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap, and differentiating the etiology may be difficult. The overall prognosis is good.
Background: Respiratory viral infections (RVIs) are frequent in preterm infants and may have long-term impact on respiratory morbidity, especially those with bronchopulmonary dysplasia (BDP). The immune response and respiratory are key defence elements, so the purpose of this study is to evaluate the immune response regulation and the respiratory epithelial barrier integrity in the preterm infants suffering RVIs during Neonatal Intensive Care Unit (NICU) admission. Materials and methods: Nasopharyngeal aspirate (NPA) was obtained, separating cells from supernatants. Viral detection was performed by RT-nested PCR, and gene expression by qPCR. Proteins were detected by western blot and ELISA or Luminex. Small airway epithelial cells (SAEC) were stimulated with Poly:IC and/or wounds. Results: Pre-infection samples from 26 preterm infants that later developed RVIs had less frequency of filaggrin gene expression and fewer protein levels compared to 23 noninfected controls. Conversely, filaggrin, IL-1β, MIP-1β, VEGF and HIF-1α levels were higher in pre-infection supernatant samples, being infection-risk biomarkers. IL-17A, RANTES, VEGF, and HIF-1α levels were higher during and post infection, while MCP-1 and amphiregulin were reduced after infection. Small airway epithelial cells (SAEC) stimulated by poly:IC reduced filaggrin gene expression and increased its levels at supernatant. Finally, poly:IC stimulation over SAEC increased TLR3 and TSLP expression, while reduced AREG. Conclusion: Filaggrin gene expression and protein quantity was reduced at cellular level of the NPA, while its secreted levels were increased in basal samples from infected newborns and in SAEC stimulated with poly:IC. Our findings highlight the importance of filaggrin as a factor facilitating RVIs.