Lisauskienė, Kristina

Background and Amis Streptococcal infection is common in children. In some cases it is responsible for severe and potentially lethal invasive conditions requiring ICU admission. A rebound of invasive streptococcal infection after COVID-19-associated barrier measures has been observed in children.

Methods In our PICU, 3 cases of severe streptococcal infection were observed.

Results In the first one, a 5-year-old girl was treated by differentiating group A streptococcal sepsis with systemic inflammatory diseases and MISC. The diagnosis of osteomyelitis, necrosis of the femoral head was finally confirmed and the girl will need a femoral replacement surgery in the future. In the second case, a 10-year-old boy was admitted due to disseminated respiratory infection, otitis, sepsis, complicated myocarditis and toxic shock syndrome. This patient required intermittent haemodialysis for about one month. He was discharged from hospital with almost no residual effects. In both cases SARS-CoV-2 antibodies came positive. In the third case, an 8-year-old patient was transferred after appendectomy and total peritonitis. The postoperative course was complicated by pleural effusions, respiratory failure, and 2 punctures of the left pleural cavity were performed. Group C streptococci grew from the abdominal cavity. The patient recovered with intensive antibacterial and surgical treatment. No SARS-CoV-2 antibodies were detected in this case. These different cases show the wide spectrum of streptococcal infection and the challenges of clinical diagnosis.

Conclusions Clinical manifestations range from mild illnesses to life-threatening conditions. If invasive infection is suspected, important to prescribe AB ASAP. In case of soft tissue, bone infection - surgical intervention is necessary.

Background: Group A Streptococcal (GAS) infection is common in pediatrics. The severity of infections varies widely. GAS sepsis is mostly due to infection of the skin or soft tissues. Case report: A 5-y/o girl presented to regional hospital PED due to limping and hip pain. ~2w ago complained of fever and sore throat. Reactive arthritis was diagnosed, patient was discharged with NSAIDs. [...].

Background Pain is one of main complaints at PED. It is still underdiagnosed and undervalued, and specific acute biomarkers are lacking. Objectives To check if there is any salivary biomarker to predict pain level in 15 or 30min with/without painkillers. Methods we conducted a pilot observational study. 30 acute pain patients were included. Exclusion:chronic conditions, fever, infection, dehydration. Gender, age, vital signs, pain characteristics were recorded. Pain was monitored throughout the visit. Saliva samples were collected at arrival, 15 and 30min after pain medication; stored at -80°C. NGF, opiorphin, cortisol ELISAs performed according to manufacturers’ instructions. Results 20-male,10-female were included; mean age–12,23±3.0y. All boys complained of trauma-related pain; girls-other origins of pain (n=8) (p<0.001). Half of male patients refused treatment; 80% of females preferred painkillers. Boys were more likely to receive opioid analgesia; girls–NSAIDS (p<0.05). Effective analgesia was achieved in 36.7%. There was no difference in pain relief within age, gender, time of pain, cause (p>0.05). Increased HR wasn‘t associated with greater need for medication (p>0.05); patients with elevated BP were more likely to use painkillers (p<0.05). Median levels of salivary cortisol–226.19 (97.95–347.74)pg/ml, NGF–25.73 (25.47–29.23)pg/ ml, opiorphin–43.32 (35.95–61.97)ng/ml. Cortisol levels increased alongside HR. Cortisol, NGF, and opiorphin concentrations were not associated with pain characteristics. Patients who reported lower pain scores after 15min, had lower HR and higher NGF values compared to those who reported moderate/severe pain (p<0.05). Higher NGF levels at arrival and after 15min were noted if patients complained of mild pain after 30min, and opiorphin values were lower in these patients at arrival (p<0.05). Conclusions Girls were more likely to receive painkillers than boys, who were more likely to receive opioid analgesics. Increased cortisol levels were observed with increasing HR. Children who complained of mild pain after 30mins had higher NGF and opiorphin values.

Backgrounds: Children who have contracted COVID are at risk of experiencing a variety of long-lasting symptoms collectively known as prolonged COVID syndrome. According to world data, about 30% of children infected with SARS-CoV-2 will experience certain symptoms. In this study, we aimed to create a continuous follow-up program for children after COVID infection. Moreover, our aim was to improve longterm periodic communication with the patient's parents to discuss her/his condition and timely recognize the signs of prolonged COVID. In addition, provide individualized assistance, monitoring of the patient and symptoms, assessment of the persistence of symptoms, and provide specific treatment. Methods: Continuous follow-up program in the frame of a prospective observational study was created and is conducted in our hospital. The program started in March 2022. Criteria for the inclusion: 1 month up to 18 years of age, diagnosed with COVID-19, or have been diagnosed with MIS-C syndrome according to the clinical criteria. After the inclusion, in a period of one year, 5 medical assessments of the state of health are planned to be carried out. In case of specific symptoms, a patient is referred to a specialist. Results: Currently, ~40 children with their caregivers are included into the program. The median age for inclusion – 9y, 42%-female. Nine children required additional consultation with a pediatric neurologist with the most frequent complaint of headaches. 4 children have ongoing consultations with a psychiatrist and continuous visits are planned. Six children were referred to a pediatric rheumatologist complaining of prolonged joint aches and the assessment regarding autoimmune diseases is ongoing. Conclusions/Learning Points: Our further plans are to collect more data and analyze the symptoms and signs according to age and gender.

Vienas veiksmingiausių staigios kūdikių mirties sindromo prevencijos būdų - saugus kūdikio miegas. Tyrimo tikslai. Išsiaiškinti tėvų turimas žinias apie staigios kūdikių mirties sindromą, palyginti, ar jos priklauso nuo tėvų amžiaus, išsilavinimo, gimdymo stacionaro, nustatyti, ar apie šį sindromą informuoja šeimos gydytojas. Tyrimo metodai. Atlikta elektroninė anketine apklausa, Į kurią įtraukti 2020 m. gimusių kūdikių tėvai, kurių kūdikių amžius - iki vienerių metų. Tyrimo rezultatai. Išanalizuotos 2 371 anketos: 87,1 proc. tėvų žino apie staigios kūdikių mirties sindromą, 12,4 proc. apie jį yra girdėję, o 0,4 proc. - visiškai nieko nežino. 67,7 proc. tėvų teigia, kad jiems stinga žinių apie staigios kūdikių mirties sindromą. 92,5 proc. tėvų atsakė, kad jų šeimos gydytojas neinformavo apie staigios kūdikių mirties sindromą. 6,6 proc. tėvų buvo netinkamai arba klaidingai suteikta informacija apie staigios kūdikių mirties sindromą. Aukštąjį universitetinį išsilavinimą turintys žmonės dažniau pasisako, kad žino, kas yra staigios kūdikių mirties sindromas (p<0,001). Tėvų žinojimas, kas yra staigios kūdikių mirties sindromas, nepriklauso nuo ligoninės, kurioje gimė jų vaikas (p>0,05). Tėvai mano, jog gauna per mažai informacijos apie staigios kūdikių mirties sindromą liek po gimdymo ligoninėje, tiek ir iš šeimos gydytojo.

Background: Pain management is one of the biggest challenges in paediatrics. Depending on their personal characteristics and level of pain tolerance, each patient needs different help or treatment. Pain is one of the main reasons for presenting to PED. The aim of this study was to compare pain assessment between gender and according changes in vital signs. Also, we wanted to check if there is any biomarker to predict pain level in 15 or 30min with or without pain medication. Methods: We conducted a pilot perspective observational study in LSMU KK PED. 30 patients that complained of acute pain.

Background: Pain is one of the main reasons for referral to a paediatric emergency department (PED). Despite the improvements, difficulties can still be observed in determining, objectively assessing the severity of pain and prescribing adequate analgesia in PED. Therefore, objectification of pain is critical to achieving optimal pain detection and management. Our aim was to investigate changes (if any) in the vital signs and salivary biomarkers with the scope to improve pain diagnostics in PED. Methods: A pilot perspective observational study was conducted in our university hospital (LSMU KK) PED. 30 patients that complained of acute pain and referred to PED were included into the study. Patient's gender, age, vital signs (heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature (t°) and oxygen saturation (SaO2)), pain characteristics (severity and duration of pain according to the used pain scale and its localization) were recorded. Saliva samples were collected and stored in -80°C conditions until analysis was performed. Samples were analysed using NGF, opiorphin and cortisol standard ELISA kit. Results: In total, data of 30 patients were included. 22 patients reported trauma and the rest for non-traumatic pain. Patients were from 7 to 17 years old with the mean age of 12,23±3.0 years. The median levels of salivary cortisol was 226.19 (97.95 – 347.74) pg/ml, NGF – 25.73 (25.47 – 29.23) pg/ml and opiorphin 43.32 (35.95 – 61.97) ng/ml. Comparing biomarker levels with physiological parameters we observed, that cortisol's levels increase alongside with HR. Same was observed after 15 and 30 minutes. Cortisol, NGF and opiorphin concentrations were not associated with type of pain, (traumatic or other) its intensity or time from the onset of pain. Discussion & Conclusions: there was no significant changes in NGF and opiorphin, but increased cortisol levels were observed with increasing HR. More patients have to be included into the study to define if the studied markers are suitable for pain objectivization.

Background and aim. Since COVID pandemics, ~50% of children can have asymptomatic infection. However, they tend to have post-covid symptoms. Due to unexplained symptom origin (without confirmed COVID), they are referred to different paediatric specialists. Aims:to analyse SARS-CoV-2 antibody levels in children referred to our University Hospital ambulatory care with unexplained symptoms, to clarify percentage of asymptomatic covid cases and related post-covid symptoms. Methods:prospective study was conducted including children up to age of 18y without previous SARS-CoV-2 infection, were not breastfed during the last months, nor vaccinated against SARS-CoV-2. Parents were asked to fill-in the questionnaire about symptoms within one year before referral. Results:in total, 124 children were included into the study, 47.5% were female. Median age was 8.6y. 63.7% had different chronic diseases, e.g., asthma or arthritis and 56.4% were allergic. 41% noted that they have had symptoms of acute infection within one year, 24% had family member who tested positive for SARS-COV-2. 24.2% of children had antibodies against SARS-CoV-2 (Ab+). No correlation between positive test of family member and Ab+ child was found. No significant difference was observed between Ab+ versus Ab- within age groups, with or without chronic diseases. There were 57 children with unexplained symptoms and 26% of those children had Ab+. Most of those symptoms were respiratory (dyspnoea, cough), followed by neurological symptoms (insomnia, tiredness). Conclusions:we did find 24% of the Ab+ children who were defined as never ill with COVID. Majority of unexplained symptoms within the Ab+ group were respiratory and/or neurological.

Background and aim To inform parents about the prevention of SIDS and to assess the knowledge of parents of newborns born in Lithuania in 2020 about SIDS. METHODS Online questionnaire including parents of babies aged 0-12 months. The total number of respondents was 2794, after excluding incomplete responses 2371 were analyzed. RESULTS The average age of the babies of the parents who completed the question naire was 6.7 (±3.4) months. 87.1% of parents said that they knew what SIDS was, 12.4% had heard of it but didn’t know exactly, 0.4% didn’t know what SIDS was at all. 81.7% of respondents searched for information on SIDS,18.3% haven’t. 40.1% of respondents answered correctly that infants are most likely to develop SIDS between 2-4 months of age, while 48% of parents thought it was most likely to happen <2 months of age. 55.6% answered correctly that breastfeeding and regular visits to health professionals reduce the risk of SIDS. 67.7% said they lacked knowledge about SIDS. 92.5% of parents said that their GP or paediatrician hadn’t talked to them about SIDS. People with a university degree more often said they know what SIDS is (p< 0.001). Parents’ knowledge is independent of the hospital where their child was born (p< 0.5), but it was related to parental age: older parents were more likely to say they knew what SIDS is (p=0.026), also parents of older infants knew better what SIDS is (p=0.014). Conclusions Parents report not receiving enought information about SID in the hospital and from GPs after delivery. Parents want to know more about SIDS, it is important to improve access to information.

Rationale: respiratory tract infections are one of the most common infection to refer to pediatric emergency (PED). Most of the diseases are self-limiting, however, bacterial lower respiratory tract infections (LRTI) when not diagnosed and treated properly can lead to increased complication and mortality rate. Moreover, it is quite hard to distinguish viral versus the bacterial cause of LRTI, thus, there is an increased tendency to use antibiotics (AB) in case of viral etiology. In this study, we aimed to analyze the tendency of AB prescriptions in LRTI in children discharged from PED.Methods: A retrospective data analysis of electronic case records was performed. In 2018, respiratory tract (RT) diseases comprised 14.7% of all (n=30.925) PED visits. Only children, with LRTI (according to ICD) were included in the study. Exclusion: neonates, upper RT, all chronic diseases, psychiatric disorders, previous antibiotic use or use on arrival to PED, hospitalized, or lack of data. All cases were divided according to age (1mo-2y, 2-5y, >5y) and type of antibiotics (AB) (broad-spectrum (BSA) and narrow spectrum (NSA)).Results: After exclusion, only 240 unhospitalized and discharged patient (52% males) records were submitted for final analysis. 51% were 2-5-year-olds, 14% - >2y, and 35% ->5 years of age. Most of them complained of fever and cough. 70 (29%) children had no pathology on auscultation. Labs (CRP and/or CBC) were performed in 81% of all children. CRP less than 60mg/l was in 93% of all whom lab test was performed. Leucocyte and neutrophil count was within the normal age range in 75% of the cases. 93% of children received lung X-ray and only 51% were evaluated (by radiologist) as pathological (infiltration/consolidation). In 63% of the cases, BSA was prescribed and only 5% did not receive any AB on discharge. BSA was most commonly prescribed in all age groups. However, younger children were more likely to be discharged with BSA. Only 48% were prescribed the correct dosage according to age. Ampicillin-sulbactam and clarithromycin were the most frequent AB (23% and 31% respectively). In addition, in 51% of the cases, the clarithromycin dosage was higher than recommended. Interestingly, 24 patients with negative auscultation and X-ray received a diagnosis of LRTI and were prescribed AB (BSA or NSA), 16 had CRP less than 60mg/l with normal CBC values.Conclusions: our study showed that most of the children with LRTI receive labs and X-rays. BSA is being prescribed in most children with uncomplicated LRTI discharged from PED. We observed that younger children were more likely to receive BSA. The most common AB were Ampicillin-sulbactam and clarithromycin. More interestingly, there were patients with no pathology on auscultation, X-ray, and no changes in labs who were diagnosed with LRTI and prescribed AB.