Michael Levy

Introduction: The COVID-19 pandemic led many countries to implement non-pharmaceutical interventions (NPIs), substantially altering paediatric healthcare. This study evaluated the impact of NPIs on morbidity and non-SARS-CoV-2 infections in paediatric intensive care units (PICUs) during the first wave of the COVID-19 pandemic. Methods: A descriptive, retrospective cohort study was conducted across three geographically distinct PICUs in Canada and France, covering January 2016 to July 2020. To assess the impact of NPIs, disease categories, patient morbidity, the length of PICU stay, mortality and the spectrum of non-SARS-CoV-2 viruses detected from April to July in 2016–2019 were compared with the same period in 2020. Additionally, a time-series analysis of non-SARS-CoV-2 virus-related PICU admissions was performed. Results: Among 12 873 patients, median age was 28.8 months (IQR 5.4–111.0), 32.3% required invasive mechanical ventilation, median PICU stay was 3.0 days (IQR 1.6–5.0) and mortality was 3.2%. Comparing the prepandemic and pandemic eras during April–July, the proportion of respiratory admissions declined significantly (29.4% vs 19.4%, p<0.01), while that of postoperative admissions remained stable (25.2% vs 22.9%, p=0.23). No significant differences were seen in ventilation use, length of stay or mortality. Time-series analysis showed a decreasing trend in non-SARS-CoV-2 viral admissions after the index date: OR 0.57 (95% CI 0.31 to 1.02) in weeks 0 to <2, 0.14 (0.08 to 0.25) in weeks 2 to <4 and 0.04 (0.02 to 0.06) in weeks 4 to 6. Conclusion: NPIs implemented during the early phase of the COVID-19 pandemic influenced PICU utilisation and reduced non-SARS-CoV-2 viral infections. Quantitative estimates of such impacts can inform surge capacity planning and the time-limited implementation of NPIs in future pandemics.

Background Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs). Objective To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs. Methods This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition. Results 63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%). Conclusions This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice. Trial registration number NCT05066464.