Background: With the emergence of the COVID-19 pandemic, increasing numbers of cases of the multisystem inflammatory syndrome in children (MIS-C) have been reported worldwide; however, it is unclear whether this syndrome has a differential pattern in children from Latin America and the Caribbean (LAC). We conducted a systematic review and meta-analysis to analyze the epidemiological, clinical, and outcome characteristics of patients with MIS-C in LAC countries.Methods: A systematic literature search was conducted in the main electronic databases and scientific meetings from March 1, 2020, to June 30, 2021. Available reports on epidemiological surveillance of countries in the region during the same period were analyzed.Results: Of the 464 relevant studies identified, 23 were included with 592 patients with MIS-C from LAC. Mean age was 6.6 years (IQR, 6–7.4 years); 60% were male. The most common clinical manifestations were fever, rash, and conjunctival injection; 59% showed Kawasaki disease. Pool proportion of shock was 52%. A total of 47% of patients were admitted to the pediatric intensive care unit (PICU), 23% required mechanical ventilation, and 74% required vasoactive drugs. Intravenous gamma globulin alone was administered in 87% of patients, and in combination with steroids in 60% of cases. Length of hospital stay was 10 days (IQR, 9–10) and PICU stay 5.75 (IQR, 5–6). Overall case fatality ratio was 4% and for those hospitalized in the PICU it was 7%.Conclusion: Limited information was available on the clinical outcomes. Improvements in the surveillance system are required to obtain a better epidemiologic overview in the region.

Background: Antibiotic-resistant gram-negative bloodstream infections (BSI) remain a leading cause morbidity and mortality in pediatric patients with a high impact on the public health system. Data in resource-limited countries, including those in Latin America and the Caribbean region, are scarce. The aim of the study was to identify risk factors for acquiring carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in children and to assess the use of resources.Methods: A retrospective case-control study was conducted to analyze demographic, epidemiological, clinical, microbiological, and outcome data as well as the use of resources between 2014 and 2019. Univariate and logistic regression analysis was performed in order to identify risk factors associated with CRE-BSI. The R software version 4.1.2 was used.Results: A total of 46 cases with CRE-BSI and 92 controls with gram-negative non-CRE-BSI were included. No statistical difference was observed regarding: median age (36 months; IQR, 11.2–117 vs. 48 months, IQR 13–119), male sex (50 vs. 60%), and underlying disease (98 vs. 91%) in cases vs. controls, respectively. The most frequent mechanism of CRE bacteremia were: KPC in 74%, OXA in 15%, and NDM in 6.5%. A total of 54.3% of cases vs. 32.6 % (p = 0.016) of controls were admitted to the pediatric intensive care unit (PICU), and 48 vs. 21% (p = 0.001) required mechanical ventilation. Bacteremia secondary to intra-abdominal infection was observed in 56.5% of cases vs. 35% of controls (p = 0.032). Previous colonization with CRE was detected in 76% of cases vs. 8% of controls. Combination antimicrobial treatment was most frequent in cases vs. control (100 vs. 56.5%). No difference was observed in median length of hospital stay (22 days; IQR, 19–31 in cases vs. 17.5 days; IQR, 10–31 in controls; p = 0.8). Overall case fatality ratio was 13 vs. 5.5%, respectively. The most statistically significant risk factors included previous PICU stay (OR, 4; 95%CI, 2–8), invasive procedures/surgery (OR, 3; 95%CI, 1–7), central venous catheter placement (OR, 6.5; 95%CI, 2–19), urinary catheter placement (OR, 9; 95%CI 4–20), mechanical ventilation (OR, 4; 95%CI, 2–10), liver transplantation (OR, 8; 95%CI, 2–26), meropenem treatment (OR, 8.4; 3.5–22.6) in univariate analysis. The logistic regression model used for multivariate analysis yielded significant differences for previous meropenem treatment (OR, 13; 95%CI, 3-77; p = 0.001), liver transplantation (OR, 13; 95%CI, 2.5–100; p = 0.006), and urinary catheter placement (OR, 9; 95%CI, 1.4–94; p = 0.03).Conclusion: CRE-BSI affects hospitalized children with underlying disease, mainly after liver transplantation, with previous urinary catheter use and receiving broad-spectrum antibiotics, leading to high PICU requirement and mortality. These risk factors will have to be taken into account in our region in order to establish adequate health policies and programs to improve antimicrobial stewardship.

Background: Data on the health impact of carbapenem-resistant Enterobacteriaceae bloodstream infections (CRE-BSIs) in pediatric populations from Latin America and the Caribbean (LAC) are limited. This systematic review aims to examine the demographic, clinical, and microbiological aspects and resource utilization of this infection in children from this region. Methods: This systematic review investigates the impact of CRE-BSIs in pediatric populations across LAC. Following the Cochrane methodology and PRISMA/MOOSE guidelines, we conducted an extensive search of different databases, including MEDLINE/PubMed, LILACS (SciELO), CENTRAL, CINAHL, Embase (Ovid), the Cochrane Library, and the World Health Organization (WHO) database, and relevant websites for published articles between January 2012 and September 2024. The review included studies on hospitalized patients under 19 years of age with CRE-BSIs. Results: Fourteen studies involving 189 patients were analyzed. Most cases were reported from Brazil, Argentina, Colombia, and Paraguay. The median age of the patients was 35 months. Key risk factors included immunocompromised status, invasive procedures, carbapenem use, and colonization. The infections were predominantly hospital-acquired, with Klebsiella pneumoniae and Serratia spp. being the most common pathogens. KPC and NDM were the primary resistance mechanisms. Most patients received combination antimicrobial therapy for a median of 17 days. An alarmingly high mortality rate at 34% was found. Conclusions: Our findings highlight that CRE-BSIs pose a significant threat to children with underlying conditions in LAC, leading to substantial morbidity and mortality. Implementing robust antimicrobial stewardship programs and effective infection control measures are crucial to curbing the spread of CRE-BSIs in the region. This review underscores the need for targeted interventions and further research to address this critical public health concern in pediatric populations across LAC.

OBJECTIVE: Endoscope-assisted repair of sagittal craniosynostosis is an effective technique that requires a learning curve. Surgical simulation models can be applied to acquire the necessary skills for this procedure. Several models with a wide range of costs have been described for training in this technique. The aim of this work was to present the results of training with a low-cost simulation model for endoscope-assisted sagittal craniosynostosis repair. METHODS: A simulation model for sagittal craniosynostosis was developed using low-cost materials. The model is easily assembled and allows successive uses. Three neurosurgery residents, 3 fellows, and 2 neurosurgeons performed a 4-session training program in sagittal craniosynostosis repair. The Global Rating Scale (GRS) score, number of errors, and the time required to perform the task were reported by 2 independent evaluators using a checklist. Measurements were compared between the first and last training using the Wilcoxon signed-rank test. All participants completed a questionnaire (5-point Likert scale) regarding the realism of the simulation model. RESULTS: A model was developed to recreate the steps required to perform an endoscope-assisted scaphocephaly repair with the patient in a simulated sphinx position. All participants improved their GRS performance between the first and final training. The median time needed to perform the initial training was 47.5 minutes (interquartile range [IQR] 44.5–48 minutes, interrater difference [IRD] p = 0.77), and for the last training was 40.5 minutes (IQR 35.5–43 minutes, IRD p > 0.99). The median number of errors reported in the initial training was 5.5 (IQR 3–7.75 errors, IRD p = 0.8), and in the last training was 1 (IQR 0.75–2.25 errors, IRD p = 0.35). There was a statistically significant difference regarding the time and number of errors between the initial and final training (p < 0.001). More than 85% of the participants found that the surface anatomy, skull and anterior fontanel, fused sagittal suture, and epidural space of the model were realistic and had appropriate detail required to perform the surgery. All respondents agreed or strongly agreed that the endoscope handling was realistic, and that the steps and skills required to complete the task were representative of those required for the real procedure. CONCLUSIONS: A low-cost sagittal craniosynostosis simulation model was developed, allowing successive uses. The acquisition of skills within the simulation was demonstrated for all participants regarding the GRS score and the number of errors and time needed to perform the task. In addition, the model was found to be realistic in terms of anatomical references and the procedural steps required for this minimally invasive technique.

Background: : Mature ovarian teratoma is the most common ovarian neoplasm in pediatrics. Laparoscopic ovary sparing surgery (LOSS) is effective and safe. Due to the expansion of this technique in recent years, education-based surgical simulation is a useful tool for skills development. Aim: : To validate a low-cost model for training LOSS in pediatric ovarian teratomas. Methods: : We developed a low-cost model, incorporated into Hands-On courses since 2018. After academic lectures, and surgical strategies video demonstration, all participants performed the procedure in pairs, in our pediatric gruyer-like-training-box, under supervision. Time and critical maneuvers were assessed. A Likert-type scale was used to evaluate: previous experience, anatomical appearance of the model, surgical anatomy compared to a real patient and utility as a training method. Statistical analysis was performed with R-Studio®. Results: : 75% considered the model as good or high degree of similarity in relation to the anatomical characteristics; and 91.3% in relation to surgical anatomy. 78.8% believe the model improves the majority of skills. Correlation in time assessment for 81 participants with different levels of experience was statistically significative (p<0.01*). Emphasis was placed on preserving the capsule and ovarian tissue without causing any injury to adjacent tissues, resulting in a homogeneous performance. Conclusion: : We saw a correlation between the previous experience of the surgeon and their performance in the model. Introducing this model in a simulation curricula would improve the learning curve. A decrease in surgical technique complications is to be expected, and should be demonstrated in future studies.