Background: During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care.Objective: The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends.Material and methods: Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June–July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine.Results: A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters via telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2–9%), text messages (1–6%), social media (3–11%), cell-phone pictures/video (1–9%), and video conferencing (1–7%) (p < 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (p < 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (p < 0.005).Conclusions: This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.

Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04–2.58) for lactate to 7.28 (95%CI: 3.04–24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04–1.80) for lactate to 11.93 (95%CI:3.35–72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

Introduction: Despite well-established immunisation programmes, the incidence of pertussis is increasing in several countries, particularly affecting young infants, who are susceptible to severe disease. We aimed to characterise pertussis cases treated in a paediatric intensive care unit. Methods: We performed a retrospective study based on review of the clinical charts of children with laboratory-confirmed pertussis admitted to a paediatric intensive care unit of an academic medical centre between January 2008 and July 2016. Results: Twenty-three children were identified, median age 40 days, 14/23 (60.9%) female, and 21/23 (91.3%) not vaccinated for Bordetella pertussis. Paroxysmal cough (100%) and apnoea (69.6%) were the most frequently found case-defining symptoms. Cyanosis and hypoxaemia (22/23, 95.7%), bradycardia (17/23, 73.9%) and apnoea (16/23, 69.6%) prompted most admissions. Fifteen patients (65.2%) needed respiratory support, invasive in 10 cases. Permissive hypercapnia was used in five patients and muscle relaxants in four. All patients had leukocytosis (median 26 600 cells/μl, 15 020-103 900 cells/μl). No leukoreduction techniques were used. Coinfection with other agents was identified in 10 patients and 14 had radiographic findings of pneumonia, which was healthcare-associated in three. Hyponatraemia was identified in five cases and seizures in one. There were no other complications of the disease and no deaths. Discussion: Disease complications, morbidity and mortality were less frequent than reported in other studies. Both prompt coinfection screening and treatment and the ventilation strategies used, sometimes with curari-Introdução: Apesar de programas de vacinação bem estabelecidos, a tosse convulsa tem reemergido em vários países, particularmente em pequenos lactentes suscetíveis a doença grave. Pretende-se caracterizar os internamentos por tosse convulsa numa unidade de cuidados intensivos pediátricos. Métodos: Estudo descritivo retrospetivo, por análise de processos clínicos de crianças com tosse convulsa confirmada laboratorialmente, internadas na unidade de cuidados intensivos pediátricos de um hospital de nível III entre janeiro de 2008 e julho de 2016. Resultados: Registaram-se 23 internamentos, mediana de idade 40 dias, 14/23 (60,9%) do sexo feminino, 21/23 (91,3%) não imunizados para Bordetella pertussis. A tosse paroxística (100%) e a apneia (69,6%) foram os sintomas definidores de caso mais frequentes. Os principais motivos de internamento foram episódios de cianose e hipoxemia (22/23, 95,7%), bradicardia (17/23, 73,9%) e apneia (16/23, 69,6%). Quinze doentes (65,2%) necessitaram de suporte ventilatório, invasivo em 10. Foi utilizada hipercapnia permissiva em cinco doentes e curarização em quatro. Verificou-se leucocitose em todos os doentes (mediana 26600 células/mL, 15 020-103 900 células/mL). Não foram usadas técnicas leucorredutoras. Identificaram-se agentes coinfetantes em 10 doentes e imagem radiológica de pneumonia em 14, nosocomial em três. Registaram-se cinco casos de hipona...

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