To identify risk factors and outcomes of patients with critical pertussis. Retrospective observational cohort study. Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman. Children aged <13 years presenting to the emergency departments and diagnosed with laboratory-confirmed pertussis by polymerase chain reaction between January 2013 and December 2018. In total, 157 patients were diagnosed with pertussis, of which 12% (n = 19) had critical pertussis. Patients with critical pertussis had a higher white blood cell count (WBCC) [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.08; P = 0.003], absolute lymphocyte count (ALC) (aOR 1.08; 95% CI 1.03-1.15; P = 0.004) and absolute neutrophil count (ANC) (aOR 1.05; 95% CI 1.01-1.10; P = 0.032) than patients with non-critical pertussis, even after multi-variate adjustment. The area under the curve for discriminatory accuracy of laboratory variables was 0.75 (95% CI 0.65-0.85), 0.74 (95% CI 0.64-0.84) and 0.72 (95% CI 0.60-0.83) for maximum WBCC, ALC and ANC, respectively, with Youden's cut-off values of 31.5 × 109/L, 19.9 × 109/L and 5.0 × 109/L, respectively. In children, higher WBCC, ALC and ANC were significant predictors of critical pertussis. A cut-off level of 31.5 × 109/L for WBCC was associated with critical pertussis.

Background: Hospital-acquired infections (HAIs) are associated with morbidity and mortality in children following congenital cardiac surgery. Our center performs approximately 200 congenital surgeries a year, but infection rates and risk factors remain unknown. This study aims to identify HAI prevalence, risk factors, and outcomes. Methods: Retrospective cross-sectional study of children who underwent congenital cardiac surgery between 2018 and 2022. The infection risk factors were identified using univariate and multivariate analyses. Assessed outcomes are length of stay, duration of mechanical ventilation, and mortality. Results: Out of 653 patients, 102 (15.6%) developed an infection. Independent risk factors for infection included preoperative critical care admission (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.01-7), delayed sternal closure (OR, 3.3; 95% CI, 1.37-8.0), peritoneal drain (OR, 12.7; 95% CI, 1.65-97), heterotaxy syndrome (OR, 5.6; 95% CI, 1-31), and extracorporeal membrane oxygenation (ECMO) placement in the critical care unit (OR, 10.6; 95% CI, 1.8-64.2). The pediatric critical care and hospital stays of patients with infections were significantly longer with 12.79 (12.15) days versus 4.07(5.47) days and 25.53 (16.86) days versus 10.21 (7.5) days, respectively. Infected patients had a longer mechanical ventilation duration, 169.5 (264.8) versus 28.16 (53.6) hours. Infections were associated with a higher mortality rate, with 7 (6.9%) versus 12 (2.2%). Conclusions: The prevalence of HAIs following cardiac surgery was 15.6%. Preoperative critical care unit admission, delayed sternal closure, heterotaxy syndrome, peritoneal drain, and ECMO placement in the critical care unit were independent risk factors. Infected patients have worse outcomes. Preventive strategies are greatly needed.

Background: Respiratory syncytial virus (RSV) causes lower respiratory tract infections, particularly in children under 24 months of age. This multicenter study explored the demographics, seasonality, clinical features, and outcomes of children with RSV. Objectives: To describe the epidemiology, seasonality, clinical characteristics, and outcomes of infants and children admitted with Respiratory Syncytial Virus bronchiolitis Methods: An eight-center retrospective cohort study included children less than 24 months old who were admitted with RSV bronchiolitis between January 2018 and December 2021. Patients’ clinical features, respiratory support, management, and outcomes were collected. Results: Of the 1585 children included, 1143 (72%) were less than 6-month-old. RSV peaked during the winter months of September to December in 2018 to 2019, but occurred earlier in 2021, with the easing of post-COVID-19 restrictions. The most common clinical features were cough (97.72%), tachypnea (76.15%), and fever (75.9%). Different types of respiratory support were needed, including high-flow nasal cannula (HFNC) in 141 (8.9%) children, Non-invasive ventilation in 341 (21.5%), and intubation in 144 (9.1%). A total of 844 (53.2%) children required admission to a pediatric intensive care unit (PICU) or pediatric high-dependency unit (PHDU). The majority of children recovered uneventfully, while 19 patients died, resulting in a mortality rate of 1.2%. Conclusion: To our knowledge, this is the largest cohort study focused specifically on RSV bronchiolitis in infants within the Middle East. The majority were younger than 6 months of age, and coughing, tachypnea, and fever were the most common symptoms. Seasonality differed between the pre- and post-COVID-19 pandemic periods. More than half of the cohort required admission to a PICU or PHDU. All patients who died had either prematurity or chronic comorbidities. Further studies are required to predict the risk factors for critical cases.

Objectives: Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region. Design: Multinational retrospective cohort study conducted between July 2022 and December 2024. Setting: Thirty-five PICUs in the six GCC countries. Patients: Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU. Interventions: None. Measurements and Main Results: A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5–89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6–16 d), and PICU stay was 5 days (IQR, 3–10 d). Hyperleukocytosis (> 30 × 10 ⁹ /L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure. Conclusions: Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.

Childhood-onset systemic lupus erythematosus (cSLE) is a multi-systemic, inflammatory autoimmune disease that affects many organs including the heart. Pericardial effusion as a primary manifestation of SLE in early infancy is very rare. It has been reported as the first symptom of SLE in adult and adolescent case reports only and the youngest reported case was a three-year-old. We report a case of a 22-month-old infant who had previously been healthy but presented with pericardial effusion and a reduced ejection fraction of 20%. She progressed to cardiogenic shock and acute renal failure and required invasive ventilation, inotropic support and temporary dialysis. She was diagnosed with SLE that was genetically confirmed as autosomal recessive SLE. Her condition improved significantly after starting SLE management with immunosuppression therapy. Pericardial effusion has resolved with medical therapy only and cardiac dysfunction has recovered. According to the available literature, this is the youngest reported case of SLE manifesting as pericardial effusion. This case highlights the importance of including SLE in the differential diagnosis for infants presenting with pericarditis, myocarditis, or pericardial effusion to guide early intervention and reduce risks associated with the disease.

The objective of this study was to assess the safety and describe treatment details of prolonged magnesium sulfate (MgSO₄) infusion for children with asthma exacerbation. A retrospective cross-sectional study included children under 13 years of age who were admitted with asthma exacerbation and received at least 24 hours of MgSO₄ infusion. One hundred children were included. No patient developed serious adverse events. The mean infusion duration was 74.2 hours. Eighty-nine percent recovered with no other bronchodilator infusions, and 94% did not require respiratory support escalation. Prolonged MgSO₄ infusion is safe at a maximum dose of 30 mg/kg/h and may be beneficial for children with asthma exacerbation. Received: 06 July 2021 Accepted: 30 December 2021 Publication Date: 21 February 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany