BackgroundAsthma is the most prevalent pediatric lung disease, characterized by T-helper 2 (Th2) cell activation and associated eosinophilic inflammation. Mounting evidence suggests a similar Th2 skewing in premature neonates who develop bronchopulmonary dysplasia (BPD), a chronic lung disease with overlapping features of asthma. Given that a substantial proportion of neonates with BPD later develop asthma, our study aimed to investigate the association between an asthma-related transcriptomic signature and BPD.MethodsUsing a previously established 10-gene asthma transcriptomic signature, we analyzed data from 111 very-low-birth-weight (VLBW) neonates over the first month of life. Meta-analysis across seven independent datasets confirmed the association of the asthma gene signature with BPD during the first week of life.ResultsThe transcriptomic signature predicted BPD severity as early as day of life 5 and stratified disease progression. Validation in an extremely preterm baboon model of BPD revealed elevated plasma concentrations of interleukin (IL)-5 and IL-6, along with increased expression of Th2-driven inflammatory cytokines in lung tissue.ConclusionOur findings provide evidence of a shared genetic and immunologic framework between asthma and BPD, offering potential biomarkers for early diagnosis and avenues for targeted therapy.ImpactThe asthma-related transcriptomic signature predicts the severity of bronchopulmonary dysplasia (BPD) as early as day five of life, providing a potential early biomarkerElevated Th2-eosinophil inflammatory markers suggest a shared pathophysiology between BPD and asthma.This study highlights the potential for early diagnosis and targeted interventions to improve long-term respiratory outcomes in preterm infants.

Objectives: To analyze the current incidence of postoperative infection for OTA/AO type C fractures of the tibial plateau and tibial plafond. Data Sources: Three medical databases: PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, were used in our systematic literature search. Search results were restricted to articles transcribed in English/Spanish and publication date after January 1, 2000, to present day. Study Selection: Inclusion criteria were studies reporting postoperative infection data for OTA/AO type 41C, 43C, or equivalent fractures of skeletally mature individuals. A minimum of 6 total fractures of interest and a frequency of 75% overall were required. Studies reporting on pathologic fractures, stress fractures, or low-energy fracture types were excluded. Data Extraction: Two authors independently screened abstracts, evaluated full-text manuscripts, and extracted relevant data from included studies. Any instances of discrepancy were resolved within the study committee by consensus. Data Synthesis: Outcomes were expressed using direct proportions (PR) with a 95% confidence interval. The effects of comorbidities on infection rates were reported using odds ratios with a 95% confidence interval. All analyses used a DerSimonian–Laird estimate with a random-effects model based on heterogeneity. The presence of publication bias was evaluated using funnel plots and Egger's tests. Conclusions: Patients with these specific fractures develop infections at a notable frequency. The rates of deep infections were approximately 6% in tibial plateau fractures and 9% in tibial plafond fractures. These results may be useful as a reference for patient counseling and other future studies aimed at minimizing postoperative infection for these injuries. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This case-control study investigated the association between isolation precautions and the frequency of infant-caregiver interaction in the NICU. Interactions were discretely counted; cases and controls were matched by isolation status. Cases had fewer interactions than controls (median, 4 vs 8; P < .0001). Further research is needed to determine whether this reduction impacts patient outcomes.

Background: Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition. Methods: We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515. Findings: Our search yielded 39 observational studies (n = 662 patients). While 71.0% of children (n = 470) were admitted to the intensive care unit, only 11 deaths (1.7%) were reported. Average length of hospital stay was 7.9 +/- 0.6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73.7%, n = 488), and vomiting (683%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22.2% (n = 147) and 44% (n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (540%) with depressed ejection fraction (45.1%, n = 262 of 581) comprising the most common aberrancy. Interpretation: Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown. (C) 2020 The Authors. Published by Elsevier Ltd.

BackgroundStudies summarizing the clinical picture of COVID-19 in children are lacking. This review characterizes clinical symptoms, laboratory, and imaging findings, as well as therapies provided to confirmed pediatric cases of COVID-19.MethodsAdhering to PRISMA guidelines, we searched four medical databases (PubMed, LitCovid, Scopus, WHO COVID-19 database) between December 1, 2019 to May 14, 2020 using the keywords "novel coronavirus", "COVID-19" or "SARS-CoV-2". We included published or in press peer-reviewed cross-sectional, case series, and case reports providing clinical signs, imaging findings, and/or laboratory results of pediatric patients who were positive for COVID-19. Risk of bias was appraised through the quality assessment tool published by the National Institutes of Health. PROSPERO registration # CRD42020182261.FindingsWe identified 131 studies across 26 countries comprising 7780 pediatric patients. Although fever (59·1%) and cough (55·9%) were the most frequent symptoms 19·3% of children were asymptomatic. Patchy lesions (21·0%) and ground-glass opacities (32·9%) depicted lung radiograph and computed tomography findings, respectively. Immunocompromised children or those with respiratory/cardiac disease comprised the largest subset of COVID-19 children with underlying medical conditions (152 of 233 individuals). Coinfections were observed in 5.6% of children and abnormal laboratory markers included serum D-dimer, procalcitonin, creatine kinase, and interleukin-6. Seven deaths were reported (0·09%) and 11 children (0·14%) met inclusion for multisystem inflammatory syndrome in children.InterpretationThis review provides evidence that children diagnosed with COVID-19 have an overall excellent prognosis. Future longitudinal studies are needed to confirm our findings and better understand which patients are at increased risk for developing severe inflammation and multiorgan failure.FundingParker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study.