Objective: Acute bronchiolitis, primarily caused by Respiratory syncytial virus (RSV), is the most common cause of hospitalization in young children. Despite international guidelines supporting clinical diagnosis, laboratory evaluations are often conducted with limited validity. We aim to evaluate the association between C-reactive protein (CRP) levels at admission and disease severity in children hospitalized due to RSV bronchiolitis. Study design: This single center retrospective cohort study included children (0-24 months old) who were hospitalized due to RSV bronchiolitis (January 2018 – March 2022) with CRP levels taken upon admission. Clinical data and severity parameters were extracted using MD-clone platform and the clinical research unit at SUMC. Results: 1,874 children (mean age of 6.7 months, 59% males) with a median CRP level of 1.92mg/dL were included. Children with elevated CRP (>1.92mg/dL) were significantly older (5.1 vs. 3.8 months, p<0.001), had higher rates of pneumonia (9.4% vs. 4.3%, p<0.001 ), urinary tract infection (UTI), (2.2% vs. 0.2%, p<0.001), acute otitis media (AOM), (1.7% vs 0.2%, p<0.001), admissions to pediatric intensive care unit (PICU) (7.4% vs 3.7%, p<0.001), antibiotic treatment (49.8% vs 37.2%, p<0.001) and longer hospitalizations (3.83 vs 3.31 days, p=0.001). Multivariable analysis predicted increased risk for UTI, PICU admission, pneumonia, and longer hospitalization (relative risk of 11.6, 2.25, 1.98, 1.44, respectively, p<0.001)). CRP thresholds of 3.51, 1.9, and 2.81 mg/dL for PICU admission, UTI, and pneumonia, were calculated using Youden’s index with AUC of 0.72, 0.62, and 0.61, respectively. Conclusions: Elevated CRP levels at admission are associated with increased disease severity and higher complication rates in children hospitalized with RSV bronchiolitis.

Background. Respiratory syncytial virus (RSV) infection is a cause of substantial morbidity and mortality in young children. There is currently no effective therapy available. Methods. This was a phase 2 study of the oral RSV fusion protein inhibitor AK0529 in infants aged 1-24 months, hospitalized with RSV infection. In part 1 patients (n=24) were randomized 2:1 to receive a single dose of AK0529 up to 4 mg/kg or placebo. In part 2 patients (n=48) were randomized 2:1 to receive AK0529 at 0.5, 1 or 2 mg/kg bid or placebo for five days. Sparse pharmacokinetic samples were assessed using population pharmacokinetics modelling. Safety, tolerability, viral load, signs and symptoms were assessed daily during treatment. Results. No safety or tolerability signals were detected for AK0529: grade ≥3 treatment-emergent adverse events occurred in 4.1% of patients in AK0529 and 4.2% in placebo groups, respectively, and none led to death or withdrawal from the study. In part 2, targeted drug exposure was reached with 2 mg/kg bid. A numerically greater reduction in median viral load with 2 mg/kg bid AK0529 than with placebo at 96 hours was observed. A -4.0 (95% CI: -4.51, -2.03) median reduction in RSV signs and symptom score from baseline to 96 hours was observed in the 2 mg/kg group, compared with -2.0 (95% CI: -3.42, -1.82) in the placebo group. Conclusions. AK0529 was well tolerated in hospitalized RSV-infected infants. Treatment with AK0529 2 mg/kg bid was observed to reduce viral load and clinical signs and symptoms.

Background: Since the outbreak of the Coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19, in comparison to the prior years. Methods: In this retrospective multicenter study, we compared the number of children that presented with FBA during the COVID-19 year (March 1st, 2020 to February 28, 2021), to the annual average of the years 2016-2019. We also compared the lockdown periods to the post-lockdown periods and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. Results: 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior four years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in post-lockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (Average of 15.4% vs 30.4%, p=0.001) Conclusion: There was no difference in the prevalence of FBA during the COVID-19 year. However, there were fewer cases during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision.

Background: Acute asthma exacerbations are a common cause for emergency department (ED) visits and hospitalizations in children. Since the outbreak of COVID-19 and the education system closure/ total lockdown in Israel on March 2020, we have noticed a decrease in pediatric ED visits and an increase in hospitalizations of asthma exacerbations. Objective: to examine the patterns of ED visits for asthma exacerbations during COVID-19 outbreak, in comparison to the previous year. Methods: a retrospective study comparing asthma related ED visits and hospitalizations among children aged 2-18 years at a tertiary center in southern Israel. Three time periods were selected: 2020A (pre- lockdown, 1/2/20-14/3/20), 2020B (lockdown, 15/3/20-15/5/20) and 2020 C (post- lockdown, 16/5/20-30/6/20) and compared to the three parallel time periods in 2019. Data regarding demographics, number of ED visits and clinical severity parameters were collected and analyzed. Results: 512 children visited the ED for asthma exacerbation: 273 children during 2019 and 239 children during 2020, with significantly fewer ED visits per day during the lockdown period (1.8 vs 1.43, p<0.001), compared to the parallel period in 2019. Significantly higher hospitalization rate (47.1% vs 33.7%, p=0.05) and longer length of stay (LOS) (3.15 vs 1.9 days, p= 0.03) were observed during the lockdown. Conclusion: lockdown is associated with fewer ED visits for asthma exacerbation, probably due to; reduced exposure to viral infections and environmental allergens, decreased availability of primary physicians and families’ reluctance to arrive to the ED. ED visits during lockdown were characterized by higher hospitalization rate and longer LOS.

Background: Rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies, with certain complication rate. Aim: to assess whether flexible bronchoscopy is an efficient and safe procedure in extraction of foreign bodies in children, compared to rigid bronchoscopy. Then, to further assess if it is associated with a shorter procedure time, and shorter length of stay in the hospital (LOS). Methods: a retrospective study including patients aged 0-18 years, that were hospitalized in Soroka University Medical Center throughout 2009-2019, and underwent flexible or rigid bronchoscopy for the removal of inhaled foreign body. The data were analyzed according to two time periods; 2009-2016 and 2017-2019. Results: from 2009-2019, 182 patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy; 40 (22%) by flexible and 142 (78%) by rigid bronchoscopy. 88.73% of rigid and 95% of flexible bronchoscopies were successful in the removal of foreign bodies (p value=0.24). The rate of major complications was higher among rigid bronchoscopy (9.2 % vs. 0%, p =0.047). From 2017 onwards, after implementation of the flexible bronchoscopy for removal of foreign bodies, 64 procedures were performed; 33 (51.6%) flexible and 31 (48.4%) rigid. Procedure length was found to be shorter via flexible bronchoscopy (42 vs 58 minutes, p = 0.016). No significant difference was found in LOS. Conclusion: Flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time. It may be the primary procedure for removal of inhaled foreign bodies.