ASPs improved the appropriateness of carbapenems prescribing overall and reduced utilization in pediatrics. Identification of areas of inappropriate prescribing will be valuable in guiding future ASP efforts.

Background: An increase in human adenovirus (HAdV) infections among hospitalized children in Singapore was observed since 2013. Young age (<2 years) and significant comorbidities have been associated with severe HAdV infections which can result in significant morbidity and mortality. Cidofovir (CDV) has been used to treat severe HAdV infections despite limited data and efficacy. Methods: This is a retrospective, observational review of infants and children 1 month to 17 years of age with laboratory-confirmed severe HAdV infection, admitted to a pediatric tertiary care hospital in Singapore between January 2013 and September 2017. Severe infection was defined as requiring intensive care unit or high dependency care at any point during hospital admission. Clinical characteristics, potential risk factors for mortality, as well as the outcome of cases treated with CDV were examined. Results: A total of 1167 children were admitted for HAdV infection, of which 85 (7.3%) were severe. For severe infections, the median age was 1.5 years (interquartile range: 0.72–3.2 years). The majority had comorbidities (69.4%) and presented with pneumonia (32.9%). Genotypes HAdV-7 (29.4%) and HAdV-3 (27.0%) were the most common HAdV genotypes identified. Thirteen (15.3%) patients died. Patients who died had a higher proportion of existing neurologic comorbidity (46.2% vs. 13.9%; P = 0.014) and presentation with pneumonia (69.2% vs. 26.4%; P = 0.008) compared with survivors. Patients who presented with pneumonia had a higher risk of 30-day mortality (odds ratio 4.3, 95% confidence interval: 1.0–28.6; P < 0.05). CDV was administered to 17 (20%) children for mainly viremia (47.1%) and/or pneumonia (41.2%). Mortality rate was 41.2% for severe HAdV cases treated with CDV. A significant proportion of patients who died when compared with recovered patients presented with pneumonia (6 of 7, 85.7% vs 1 of 10, 10%; P = 0.004). All 8 patients who had viremia received CDV and survived. Conclusions: Mortality can be high in pediatric patients with severe HAdV infections. HAdV-7 and HAdV-3 were the most common genotypes identified in our cohort with severe HAdV infection. Pneumonia is a potential risk factor for mortality in severe HAdV infections in our cohort. Early CDV administration may be considered in patients with severe HAdV infection and existing comorbidities but more studies are required.

We describe a case of a 10-year-old immunocompetent girl with a left renal abscess due to Group C Salmonella ( Salmonella serovar Oranienburg). Percutaneous drainage of the abscess was done. She also received 2 weeks of intravenous ceftriaxone, followed by 4 weeks of oral co-trimoxazole with resolution seen on ultrasound. A review of pediatric Salmonella renal abscesses is also presented.

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formed a normal distribution curve, with the 97.5th centile falling at 16.8 mIU/L. Therefore, cord TSH exceeding 16.8 mIU/L formed the basis for screening cut-off TSH values at SGH since 2013. Objectives The objective of our study was to determine the prevalence of CH amongst newborn infants born at SGH who had umbilical cord TSH levels in the borderline range 16.8 -25.0 mIU/L. Methods In this retrospective cohort study, livebirths from 1 January 2015 to 31 October 2020 who had borderline cord TSH levels of 16.8 -25.0 mIU/Lwere included. Neonates with raised cord TSH !16.8 mIU/L had thyroid function repeated on day 6-8 and 2-weekly thereafter. Demographic and birth data were collected, including cord free thyroxine (fT4) and TSH levels, aetiology, age at initiation of treatment, initial dose and length of outpatient follow-up.Results Our screening program based on cord TSH cut-off !16.8 mIU/L resulted in a positive screening rate of 3.63%. A total of 276 of 10,172 neonates (2.71%) born during the study period was found to have cord TSH levels in the range 16.8-25.0 mIU/L. The mean (±S.D.) gestational age was 38.2 (±1.9) weeks and mean (±S.D.) birth weight was 3040 (±486) grams. There were three cases of congenital hypothyroidism amongst 276 livebirths, giving a prevalence rate of 1 in 92. All 3 neonates were born at term with mean birth weight 3,287 grams at a mean gestational age 38 weeks. Of the 3, one was diagnosed postnatally with trisomy 21 complicated by patent ductus and ventricular septal defect, while another was born to a mother with Graves' disease. All had thyroid dysgenesis and were given daily L-thyroxine replacement. Conclusions Our current newborn screening program for congenital hypothyroidism based on an umbilical cord TSH cut-off !16.8 mIU/L resulted in a positive screening rate of 3.63%. Amongst 276 neonates with TSH levels of 16.8 -25.0 mIU/L, three term infants were diagnosed with congenital hypothyroidism, giving a prevalence rate of 1 in 92. These 3 cases of CH would have been missed if the screening cut-off level were increased to 25 mIU/L. A better screening TSH cut-off at the 97.5th centile of the distribution curve appeared to be 18 mIU/L instead of 16.8 mIU/L.