Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and endoscopic ultrasound with an echobronchoscope‐guided fine needle aspiration (EUS‐B‐FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. Objective To describe the utility and safety of EBUS‐TBNA and EUS‐B‐FNA in children with mediastinal pathologies of unknown etiology. Design Chart review. Setting Pediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018. Patients Children <18 years of age with mediastinal pathologies of undefined etiology. Methods Case records of children who underwent EBUS‐TBNA and EUS‐B‐FNA were reviewed. Data on demographic profile, clinical features, laboratory investigations, the technique of EBUS‐TBNA/ EUS –B‐ FNA, complications, and findings were collected. Results Thirty children (19 males) with mean (SD) age of 9.6 (±3.5) years underwent endobronchial procedures. Median (IQR) weight(kg) and height(cm) were 29 (19.5, 35) and 134 (125, 150) respectively. Tuberculosis was the most common preprocedure clinical diagnosis (73.3%), followed by lymphoma (13.3%). Presenting features were fever (80%), cough (53.3%), hepatomegaly (13%), peripheral lymphadenopathy (21.7%), and positive tuberculin skin test (63.3%). Approximately one fourth were on antitubercular therapy without definite evidence of TB. Conscious sedation was used for the procedures: midazolam and fentanyl (n = 22), propofol (n = 8). Transesophageal, transtracheal, and both routes were used in 20 (66.6%), 7 (23.3%), and 3 (10.1%), respectively. Lymph‐nodes were sampled in 24 children (subcarinal in 16, right paratracheal in 4 and both in 4). Mean (SD) size of lymph node (in cm) on EBUS was 1.93(±0.5) and median (IQR) number of FNAC needle passes per node were 2 (2, 4). The diagnosis was confirmed in 11 (36.6%, tuberculosis in 10 by GeneXpert/ MGIT/ cytopath and lymphoma in one) patients. Only 3.3% had a minor complication. Conclusion EBUS‐TBNA and EUS‐B‐FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.

Objectives To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic. Methods This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included. Results Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d. Conclusions In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.

The illness severity scoring systems provide objective measures for inter- and intra-unit comparisons with time and also provide useful information for comparing the severity of illness of patients, at the time of enrollment into clinical trials. These scores are an essential part of the improvement in clinical decisions and in stratifying patients with poor outcomes. Appropriate application of these models helps in decision-making at the right time and in decreasing mortality. However, it is also important to note that the choice of illness scores should accurately match the setting in which they are designed. In Indian setting, there is no Pediatric Intensive Care Unit illness severity score is designed until now as per our patient profile and resources. The purpose of this review article is to provide an idea regarding the evolution of illness severity scores in developed countries till date along with their utility. This review emphasizes the need for the development of pediatric illness severity score as per the local resources.

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