Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

When in-person learning returned for many students, one of the most common ways to prevent the spread of COVID-19 in schools was for schools to close if a specific number of staff and students became sick with the disease or, in some cases, if the community spread reached a certain level. Such school closures not only disrupted the education of affected children, but could keep children from accessing the resources necessary to thrive. An 

 examines whether the use of targeted approaches could be just as effective as school closures to reduce infection rates.

The investigators compared the infection rates in grades 1-10 in schools in 7 boroughs in Oslo, Norway from February 15, 2021 to April 18, 2021. All of the schools utilized strict targeted approaches, but schools were closed as required for students in grades 5 to 10. Nationwide registries were used to collect information.

A positive COVID-19 test was obtained for 616 students in grade 1-4, 452 in grades 5-7, and 446 in grades 8-10 during the study period. The Alpha variant was the predominant variant circulating at the time. The investigators found a statistically significant reduction in the post-intervention trends seen in grades 1-4 (coef -1.26, 95%CI -2.44 to -0.09). Furthermore, they found no difference in the trends between grades 1-4 and 5-7 (coef 0.66, 95%CI -1.25 to 2.58) nor between grades 1-4 and 8-10 (coef -0.63, 95%CI -2.30 to 1.04).

The investigators concluded that school closures were no more efficacious at reducing the rate of student infections than using targeted measures. The findings suggest that the use of just strict mitigation measures such as rigorous adherence to social distancing or masking could be an effective way to keep children safe without disrupting their education. 

1. Rotevatn T, Elstrøm P, Greve-Isdahl M, Surén P, Johansen T, Astrup E. School closure versus targeted control measures for SARS-CoV-2 infection. 

. March 11, 2022. Epub ahead of print. doi: 10.1542/peds.2021-055071

Articles

School closures have been the go-to move to prevent the spread of COVID-19, but a report investigates whether the use of strict mitigation can work just as well without the need to disrupt a child’s in-person schooling.

Can strict mitigation work as well as closure to reduce the spread of COVID-19?

Not all emergency departments have the staff and equipment necessary to provide optimal care to children. A 

 examines whether a high degree of readiness for pediatric patients in hospital emergency departments is linked to an improvement in the long-term outcomes for children who are treated in them.

Investigators ran a retrospective cohort study that examined injured children aged younger than 18 years who lived in 8 states and had either admission, transfer to, or injury-related death at 1 of 146 trauma centers that were participated. Children were included in the study, regardless of whether treatment occurred in their state of residence. They created subgroups for children such as Injury Severity Score (ISS) of 16 or more; any Abbreviated Injury Scale (AIS) score of 3 or more; head AIS score of 3 or more; and need for early critical resources. Data were from January 2012 to December 2017 and follow-up occurred through December 2018. The initial readiness of the emergency departments was assessed using the weighted Pediatric Readiness Score (range, 0-100) from the 2013 National Pediatric Readiness Project assessment.

There were 88,071 children included in the study who had a median age of 11 years. The investigators found that 1974 of them died within a year of the first emergency department visit, which included 1768 who died during the course of hospitalization and 206 who died after being discharged. The subgroups included 12,752 (14.5%) with an ISS of 16 or more, 28 402 (32.2%) with any AIS score of 3 or more, 13,348 (15.2%) with a head AIS of 3 or more, and 9048 (10.3%) requiring early critical resources. When compared to emergency departments in the lowest weighted Pediatric Readiness Score quartile, children who were cared for in emergency departments in the highest quartile had lower hazard of death to 1 year (adjusted hazard ratio, 0.70; 95% CI, 0.56-0.88).

The investigators concluded that being treated in a trauma center emergency department with a high degree of readiness was linked to a lower risk of death that lasted to 1 year. Furthermore, a high level of readiness was independently linked to long-term survival among children with injuries. The findings continue to confirm that care tailored to children’s needs leads to better outcomes.

Newgard C, Lin A, Goldhaber-Fiebert J, et al. Association of emergency department pediatric readiness with mortality to 1 year among injured children treated at trauma centers. 

. February 2, 2022.Epub ahead of print. doi:10.1001/jamasurg.2021.7419

Does readiness to treat pediatric patients in the emergency department lead to less mortality in the year following presentation? An investigation offers answers.

Does the readiness of emergency services impact mortality?

With the COVID-19 pandemic reaching an unprecedented crescendo and pediatric cases continuing to become more prominent with each new variant of the disease, an understanding of how many pediatric cases that initially present and receive testing in an emergency department experience a severe outcome or death is more important than ever. A 

 aims to find the proportion of pediatric patients who experience such outcomes within 14 days.

Investigators performed a prospective cohort study with 14-day follow-up that enrolled participants between March 2020 and June 2021. They included children and adolescents aged younger than 18 years who were tested for COVID-19 infection at an emergency department in 10 countries: Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Infection was confirmed via a polymerase chain reaction test. Severe outcomes were either the occurrence of a complication such as encephalitis or cardiac arrest or the performance of an intervention linked to a severe occurrence such as chest drainage or positive pressure ventilation, as well as death.

There were 3221 patients included in the study, with 2007 coming from the United States and 484 self-reporting a chronic illness. The median age of the cohort was 3 years. Following 14 days of follow-up, 735 children required hospitalization; 107 recorded severe outcomes; and 4 children had died. Investigators noted that there were several characteristic that were linked to severe outcomes, including being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). In a subcohort of patients who were sent home from the emergency department after being tested and completed the 14 days of follow-up, 50 were subsequently hospitalized and 12 had severe outcomes.

The investigators concluded that about 3% of pediatric patients who tested positive for COVID-19 in the emergency department had severe outcomes within 2 weeks of their initial visit. The risk was much less for children who were sent home from the emergency department than among those who were kept in the hospital. The risk factors noted such as age and underlying chronic illness could be useful when determining a patient’s clinical care.

Funk A, Florin T, Kupperman N, et al. Outcomes of SARS-CoV-2–positive youths tested in emergency departments: the global PERN–COVID-19 study. 

. 2022;5(1):e2142322. doi:10.1001/jamanetworkopen.2021.42322

A global study examines how often severe outcomes occur within 14 days of a positive COVID-19 test occurring in an emergency department (ED).

Looking into the rate of severe COVID-19 outcomes for kids tested in the ED   

Neurodevelopmental disorders have been linked to poor social and health outcomes. An understanding of population data on age at time of diagnosis, demographic variations, and incidence are incredibly helpful in the identification of risk factors that are modifiable and can impact the planning of services and intervention. A

 new population-based cohort investigation

Investigators used nationwide data using birth cohorts from the 2000-2014 Medicaid Analytic eXtract and the 2003-2015 IBM MarketScan Research Database to find children who were publicly and privately insured at the time of their birth. Identified conditions included attention-deficit/hyperactivity disorder, learning disabilities, speech or language disorders, developmental coordination disorders, intellectual disabilities, neurodevelopmental disorders, autism spectrum disorders, and behavioral disorders. Analyses estimated the incidence and timing of diagnosis, which was stratified by child’s sex, birth year, maternal age at delivery, and race and ethnicity.

The sample included 2,070,541 children who were publicly insured and 1,309,900 children insured privately at the time of birth. By their 8th birth, 23.9% of publicly insured children and 11.0% of privately insured children had been given a diagnosis of at least 1 neurodevelopmental disorder:

attention-deficit/hyperactivity disorder, 14.5% and 5.8%;

speech or language disorder, 8.4% and 4.5%;

developmental coordination disorder, 0.9% and 0.7%;

intellectual disability, 0.7% and 0.1%; and

The risk of diagnosis was found to be much higher among boys (incidence of ≥1 neurodevelopmental disorder by age 8 years for boys vs girls: 30.7% vs 16.7% among publicly insured children and 15.0% vs 6.7% among privately insured children) and White children (30.2% vs 9.1% among Asian children, 23.0% among Black children, 15.4% among Hispanic children, and 22.7% among children of unknown race or ethnicity; information on race and ethnicity was available only for publicly insured children). With the exception of attention-deficit/hyperactivity disorder, diagnosis occurred slightly earlier for children with private insurance. Co-occurring disorders were common, particularly in children who had intellectual disability and autism spectrum disorder (>70% had ≥1 other disorder).

The investigators concluded that there was a fairly high incidence of and co-occurrence of neurodevelopmental disorders, but a disparity in incidence and timing of diagnosis by insurance type and race and ethnicity existed. They believe the results show the importance of timely, accessible developmental assessments and educational services.

1. Straub L, Bateman B, Hernandez-Diaz S, et al. Neurodevelopmental disorders among publicly or privately insured children in the United States. 

. Epub ahead of print. January 5, 2022. doi:10.1001/jamapsychiatry.2021.3815

Understanding the population characteristics of neurodevelopmental disorders is an important way to find modifiable risk factors and help determine needed services.

Examining the population characteristics of neurodevelopmental disorders in pediatrics

The US Food and Drug Administration recently expanded the emergency use authorization for COVID-19 Pfizer/BioNTech booster to include pediatric patients aged 12 years and older, the Centers for Disease Control and Prevention (CDC) 

 the Advisory Committee on Immunization Practices’ recommendation to expand boosters to include children aged 12 to 15 years.

 The organization recommends that people aged 12 to 17 years receive a booster dose 5 months after undergoing the primary vaccine series.

In support of this expansion, CDC director, Rochelle Walensky, MD, MPH, said, “it is critical that we protect our children and teens from COVID-19 infection and the complications of severe disease. We now recommend that all adolescents aged 12-17 years should receive a booster shot 5 months after their primary series. This booster dose will provide optimized protection against COVID-19 and the Omicron variant. I encourage all parents to keep their children up to date with CDC’s COVID-19 vaccine recommendations.”

1. Centers for Disease Control and Prevention. CDC expands booster shot eligibility and strengthens recommendations for 12-17 year olds. Published January 5, 2022. Accessed January 10, 2022. 

https://www.cdc.gov/media/releases/2022/s0105-Booster-Shot.html

The Centers for Disease and Control and Prevention (CDC) has given their support for giving a COVID-19 booster to children aged 12 to 15 years.

CDC expands COVID-19 booster recommendations to kids 12-15

The day after Thanksgiving 2021 the news of a new variant with several mutations was announced and quickly named Omicron, as well as a variant of concern. It has since become the predominant variant causing COVID-19 cases.



 sat down with Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, to discuss what's known about the variant. She also discusses the latest on the vaccine for children aged younger than 5 years.

Podcasts

Contemporary Pediatrics sat down with Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, to discuss what's known about the variant. She also discusses the latest on the vaccine for children aged younger than 5 years.