Publications by authors named "Shira Gertz"
Women in Pediatric Critical Care Medicine: Translating the Truth in the Trend.
Pediatr Crit Care Med
October 2024
Hematopoietic cell transplantation (HCT) uses cytotoxic chemotherapy and/or radiation followed by intravenous infusion of stem cells to cure malignancies, bone marrow failure and inborn errors of immunity, hemoglobin and metabolism. Lung injury is a known complication of the process, due in part to disruption in the pulmonary microenvironment by insults such as infection, alloreactive inflammation and cellular toxicity. How microorganisms, immunity and the respiratory epithelium interact to contribute to lung injury is uncertain, limiting the development of prevention and treatment strategies.
View Article and Find Full Text PDFPediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S.
View Article and Find Full Text PDFArticle Synopsis
- A study investigated the impact of pre-existing immunocompromising conditions (ICCs) on pediatric patients with acute COVID-19 admitted to intensive care across 55 hospitals in the U.S.!
- Out of 1,274 patients, 105 had ICCs, which were linked to higher in-hospital mortality (11.4% vs. 4.6%) and longer hospital stays, although initial disease severity was similar between those with and without ICCs.!
- Despite the challenges, most patients with ICCs survived and left the hospital without new severe health issues, highlighting a positive aspect of the outcomes for these vulnerable patients.!
Article Synopsis
- This study aims to define immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it with regular pediatric acute respiratory distress syndrome (PARDS).
- Data were analyzed from the PARDIE study, which included a wide dataset of children with PARDS across 145 PICUs in 27 countries.
- Findings indicate that children with I-PARDS have a higher severity of illness, increased PICU mortality, and are less likely to be extubated successfully within 28 days compared to those with regular PARDS.
Introduction: Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) is a network fostering clinical research to optimize care for critically ill children. We aim to examine the efforts of the PALISI Network to increase gender parity in research, as evidenced by authorship.
Methods: The first and senior authors of all published PALISI articles from 2002 to 2021 were analyzed for gender of presentation.
Article Synopsis
- A study analyzed the clinical characteristics and vaccination status of young children hospitalized for acute COVID-19 across 28 pediatric hospitals in the U.S. from September 2022 to May 2023.
- Of the 597 children examined, only 4.5% had completed their primary COVID-19 vaccination series, while 7.0% had started but not completed it, with the majority being unvaccinated.
- Most children admitted with severe COVID-19, including those requiring intensive care, were previously healthy and had not initiated vaccination, highlighting a concerning gap in immunization among vaccine-eligible young kids.
Article Synopsis
- Lung injury is really important for kids' survival after getting special treatments for blood diseases, and scientists want to learn more about how germs and the body work together in the lungs.
- In a big study, researchers looked at lung samples from 229 kids at 32 hospitals over 8 years and found 4 different groups of patients based on their lung microbe makeup.
- Each group had different health outcomes: one group had low infection rates and low death rates, while others had high infection and death rates, showing that the type of lung microbes can greatly affect survival.
Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
Methods: Across 25 U.S.
Effectiveness of Maternal mRNA COVID-19 Vaccination During Pregnancy Against COVID-19-Associated Hospitalizations in Infants Aged <6 Months During SARS-CoV-2 Omicron Predominance - 20 States, March 9, 2022-May 31, 2023.
MMWR Morb Mortal Wkly Rep
September 2023
Article Synopsis
- Infants under 6 months are not eligible for COVID-19 vaccines, but maternal vaccination during pregnancy can help protect these infants from being hospitalized due to COVID-19.
- A study found that vaccinated mothers showed a 35% effectiveness in preventing COVID-19-related hospitalizations in infants under 6 months and 54% for those under 3 months.
- Vaccinated mothers had lower rates of severe outcomes for their infants, such as intensive care unit admissions and the need for mechanical ventilation, highlighting the importance of vaccination for expectant mothers.*
Importance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.
Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.
Design, Setting, And Participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states.
Objectives: To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections.
Design: We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2-4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days.
Importance: Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge.
Objective: To characterize neurological, psychological, and quality of life sequelae after MIS-C.
Design, Setting, And Participants: This cross-sectional cohort study was conducted in the US and Canada.
Article Synopsis
- This study focused on children and adolescents hospitalized for COVID-19, evaluating the prevalence of bacterial coinfections and the use of empiric antibiotics during their stay.
- Of the 532 patients analyzed, 63.3% received antibiotics, but only 7.1% had bacterial coinfections, with just 3.0% having respiratory bacterial coinfections.
- The results indicate that while antibiotic use is common in these cases, bacterial coinfections are rare, suggesting that more careful antibiotic prescribing and quicker assessment for coinfection could be beneficial.
Aseptic meningitis is a rare but potentially serious complication of intravenous immunoglobulin treatment. In this case series, meningitic symptoms following intravenous immunoglobulin initiation in patients with multisystem inflammatory syndrome were rare (7/2,086 [0.3%]).
View Article and Find Full Text PDFBackground: Autoantibodies against type I IFNs occur in approximately 10% of adults with life-threatening coronavirus disease 2019 (COVID-19). The frequency of anti-IFN autoantibodies in children with severe sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is unknown.
Objective: We quantified anti-type I IFN autoantibodies in a multicenter cohort of children with severe COVID-19, multisystem inflammatory syndrome in children (MIS-C), and mild SARS-CoV-2 infections.
Association of Asthma With Treatments and Outcomes in Children With Critical Influenza.
J Allergy Clin Immunol Pract
March 2023
Background: Hospitalization for severe influenza infection in childhood may result in postdischarge sequelae.
Objective: To evaluate inpatient management and postdischarge sequelae in children with critical respiratory illness owing to influenza with or without preexisting asthma.
Methods: This was a prospective, observational multicenter study of children (aged 8 months to 17 years) admitted to a pediatric intensive care or high-acuity unit (in November 2019 to April 2020) for influenza.
Importance: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.
Objective: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021.
Design, Setting, And Participants: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge.
Factors Associated With COVID-19 Non-vaccination in Adolescents Hospitalized Without COVID-19.
J Pediatric Infect Dis Soc
February 2023
Background: Pfizer-BioNTech COVID-19 vaccine received emergency use authorization for persons ≥ 16 years in December 2020 and for adolescents 12-15 years in May 2021. Despite the clear benefits and favorable safety profile, vaccine uptake in adolescents has been suboptimal. We sought to assess factors associated with COVID-19 non-vaccination in adolescents 12-18 years of age.
View Article and Find Full Text PDFBackground Cardiac complications related to COVID-19 in children and adolescents include ventricular dysfunction, myocarditis, coronary artery aneurysm, and bradyarrhythmias, but tachyarrhythmias are less understood. The goal of this study was to evaluate the frequency, characteristics, and outcomes of children and adolescents experiencing tachyarrhythmias while hospitalized for acute severe COVID-19 or multisystem inflammatory syndrome in children. Methods and Results This study involved a case series of 63 patients with tachyarrhythmias reported in a public health surveillance registry of patients aged <21 years hospitalized from March 15, 2020, to December 31, 2021, at 63 US hospitals.
View Article and Find Full Text PDFThe aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children posthematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). This investigation was a secondary analysis of a multicenter retrospective cohort of children (1month to 21 years) postallogeneic HCT with PARDS receiving invasive mechanical ventilation (IMV) from 2009 to 2014. Daily FO % (FO%) and daily oxygenation index (OI) were calculated for each patient up to the first week of IMV (day 0 = intubation).
View Article and Find Full Text PDFBackground: Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood.
Methods: In a multicenter, case-control, public health investigation of children ages 5-18 years hospitalized from 1 July 2021 to 7 April 2022, we compared the odds of being fully vaccinated (2 doses of BNT162b2 vaccine ≥28 days before hospital admission) between MIS-C case-patients and hospital-based controls who tested negative for SARS-CoV-2.
Objectives: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C).
Methods: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission.
Article Synopsis
- Infants under 6 months old are at high risk for severe Covid-19 complications and can't be vaccinated, but maternal vaccination may provide them with protective antibodies.
- A study comparing hospitalized infants with and without Covid-19 found that the maternal vaccination effectiveness against hospitalization was 52% overall, varying significantly between the delta (80%) and omicron (38%) periods.
- Among 537 case infants, a small percentage had vaccinated mothers, and only 21% required intensive care, with two deaths occurring in unvaccinated cases.