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

Miranda Hester

Much of the focus on coronavirus disease 2019 (COVID-19) has been on adult cases, but there were, in fact, over 2,000,000 pediatric cases in 2020. And although many of the cases were mild, some required mechanical ventilation or admission to the intensive care unit. A

looked at the associations between patient characteristics and severe COVID-19 in pediatric patients who were hospitalized.

The investigators used discharge data from the Premier Healthcare Database Special COVID-19 Release, which was used to find inpatient or emergency department cases with a primary or secondary COVID-19 discharge diagnosis from March 1 through October 31, 2020. In the report, severe COVID-19 was defined as requiring treating in either an intensive care unit or step-down unit, the use of invasive mechanical ventilation, or death.

The cohort included 20,714 patients with COVID-19. Slightly more than half of the cohort were girls aged 12 to 18 years. There were 8148 Hispanic or Latino patients and 5054 who were non-Hispanic Black. Roughly 29% of the patients had 1 or more chronic condition. A subcohort of 2430 patients required hospitalization because of COVID-19 and 756 patients had severe COVID-19. The investigators noted an increased link to COVID-19 in patients who had 1 or more chronic condition when compared to those who had none (adjusted odd ratio [aOR], 3.27; 95% CI, 2.44-4.37); children aged 2 to 11 years versus those aged 12 to 18 years (aORs, 1.53; 95% CI, 1.11-2.13 and 1.53; 95% CI, 1.04-2.23, respectively); and in male versus female patients (aOR, 1.52; 95% CI, 1.26-1.83). No statistically significant link was noted between either insurance type or race/ethnicity and severe COVID-19.

The investigators concluded that younger children seemed to have an increased association with severe COVID-19, although they did note that younger children might be admitted to the intensive care unit due more to an abundance of caution than actual disease severity. They also found independent links to severe COVID-19 with being male and pre-existing chronic conditions.

1. Preston L, Chevinsky J, Kompaniyets L, et al. Characteristics and disease severity of US children and adolescents diagnosed with COVID-19. 

. 2021;4(4):e215298. doi:10.1001/jamanetworkopen.2021.5298

Articles

Coronavirus disease 2019 (COVID-19) may be mild in most cases for children, but severe cases do happen. An investigation offers insight into what factors may contribute to those cases.

What contributes to severe COVID-19 in kids   

Otitis media is one of the most common reason for a young child’s visit to the pediatrician’s office. The advent of the pneumococcal vaccine has had an impact on the otopathogens that cause otitis media. However, the serotype-specific effectiveness of the 7- and 13-valent pneumococcal vaccines is little known, especially because of the lack of culture-positive cases. A report in 

Investigators ran a study from October 2009 to July 2013. It included all cases of children aged 5 to 35 months who had otitis media who had a middle-ear fluid culture collected. Most of the otitis media cases included in the study were complex and were either recurrent/non-responsive, spontaneously draining, or chronic with effusion. The controls were peers who had rotavirus-negative gastroenteritis and had a similar ethnic distribution and geographic location as the children with otitis media.

There were a total of 223 otitis media cases and 1370 control subjects included in the study. The investigators found that serotypes 19F and 19A were responsible for 56.1% of all vaccine-serotype otitis media. The efficacy of the 7-valent vaccine against otitis media due the 7-valent vaccine serotypes was 57.2% and the 13-valent vaccine against otitis media due the 13-valent vaccine serotypes was 77.4%. Additionally, the 13-valent pneumococcal vaccine had 67.4% efficacy for six non-valent 7 serotypes; 91.3% against serotype 19A-otitis media.

The investigators concluded that both the 7-valent and 13-valent pneumococcal vaccines were effective in preventing complex otitis media that was triggered by the targeted serotypes. A key limitation to the study was the fact that children with uncomplicated acute otitis media were not included in the study, likely due to the lack of culture collection in such cases.

1. Dagan R, van der Beek B, Ben-Shimol S, Pilishvili T, Givon-Lavi N. Effectiveness of the seven- and thirteen valent pneumococcal conjugate vaccines against vaccine-serotype otitis media. 

A report offers insight into how 7-valent and 13-valent pneumococcal vaccines could help prevent certain serotypes of otitis media.

Pneumococcal vaccines help prevent otitis media

Multiple guidelines recommend that teenagers get between 8 and 10 hours of sleep every night. Worries about a lack of adequate sleep have driven the call to push the school start time for middle school and high school later than the common 7:00 to 7:30 am now used. Further challenging the need for quality sleep in this age group is research showing how electronic devices can have a negative impact on teenagers’ sleep hygiene. However, insomnia can also be a problem in this age group and an

 looks into whether a prevention program was effective in reducing insomnia in those at risk.

The investigators ran a randomized controlled trial that compared a nonactive control group with a weekly insomnia prevention program. Each participant was assessed at the study’s baseline as well as 6 and 12 months following the intervention. Those assessing the participants had been blinded to the randomization.

There were 242 teenagers who had a family history of insomnia and subthreshold insomnia symptoms included in the study. They were randomly assigned into the control group (n = 121; mean age = 15.0 ± 1.7; female: 62.0%) and intervention group (n = 121; mean age = 14.7 ± 1.8; female: 51.2%). When compared to the control group, a lower incidence rate of both acute and chronic insomnia disorder was found in the intervention group (5.8% vs 20.7%; 

 = .002; number needed to treat = 6.7; hazard ratio = 0.29; 95% CI: 0.12–0.66; 

 = .003) over the course of the 12 month follow-up. Additionally, the teenagers in the intervention group had reduced vulnerability to stress-related insomnia (

 = .03) as well as decreased insomnia symptoms (

 = .03) both after the intervention and over the course of the 12 month follow-up. Postintervention, the researchers also noted better sleep hygiene practices (

 = .04), and increased total sleep time (

 = .05). Additionally, at the 12 month follow-up, the group that had undergone the invention recounted fewer depressive symptoms than the control group (

The investigators concluded that a brief cognitive behavioral program was effective in preventing the onset of insomnia. Given the sleep needs of adolescents, using such programs could be an effective way of getting affected teenagers back to healthier sleep schedules.

1. Chan N, Li S, Zhang J, et al. A prevention program for insomnia in at-risk adolescents: a randomized controlled study. 

. February 24, 2021. Epub ahead of print. doi:10.1542/peds.2020-006833

It is crucial that teenagers get adequate sleep, but unfortunately some may battle insomnia. Could a brief intervention help improve outcomes?

Using a program to combat teen insomnia

The US Food and Drug Administration (FDA) has given an 

 for Eli Lilly’s monoclonal antibodies bamlanivimab and etesevimab administered together to treat mild to moderate coronavirus disease 2019 (COVID-19) in both adults and pediatric patients who are aged 12 years and older, weigh at least 88 pounds, and are at high risk of developing severe COVID-19.

The authorization was based on a clinical trial of patients with COVID-19 at risk of disease progression. Participants were given an intravenous infusion of bamlanivimab (2800mg) and etesevimab (2800mg) that was administered together. The dose significantly reduced hospitalization and death related to COVID-19 over the course of 29 days of follow-up when compared to a placebo. The efficacy and safety is under continual evaluation.

Possible side effects include pruritus, rash, dizziness, and nausea. Serious and unexpected adverse effects were observed with bamlanivimab, both with and without coadministration of etesevimab, and included infusion-related reactions, anaphylaxis, and hypersensitivity. Clinical worsening after receiving bamlanivimab has been noted, but it’s unknown whether this was because of progression of COVID-19 or because of bamlanivimab use. Additionally, bamlanivimab and etesevimab are not authorized for use in patients who are hospitalized because of COVID-19 or require oxygen therapy because of the disease.

In the press release from the FDA for the authorization, Patrizia Cavazzoni, MD, acting director of the FDA’s Center for Drug Evaluation and Research said, “Today’s action, which provides another treatment for COVID-19, reflects the FDA’s strong commitment to working with sponsors to expand potential treatment options health care providers can use to fight this pandemic. As part of our Coronavirus Treatment Acceleration Program, the FDA uses every resource at our disposal to make treatments such as these monoclonal antibodies available while continuing to study their safety and effectiveness.”

US Food and Drug Administration. Coronavirus (COVID-19) update: FDA authorizes monoclonal antibodies for treatment of COVID-19. US Food and Drug Administration. Published February 9, 2021. Accessed February 11, 2021. 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19-0

The US Food and Drug Administration (FDA) issued an emergency use authorization (EUA) of monoclonal antibodies bamlanivimab and etesevimab to treat mild coronavirus disease 2019 (COVID-19) in both pediatric and adult patients.

Miranda Hester

Articles

What contributes to severe COVID-19 in kids

Pneumococcal vaccines help prevent otitis media

Using a program to combat teen insomnia

FDA issues EUA for bamlanivimab and etesevimab to treat COVID-19