- Pediatric Infectious Diseases
Clinical Assistant Professor, Pediatrics - Infectious Diseases
Board Certification: American Board of Pediatrics, Pediatric Infectious Diseases (2019)
Fellowship: Children's Hospital of Philadelphia Infectious Disease Program (2019) PA
Board Certification: American Board of Pediatrics, Pediatrics (2016)
Residency: UCSF Benioff Childrens Hospital Pediatric Residency (2016) CA
Medical Education: University of California San Diego School of Medicine (2013) CA
Medications and Adherence to Treatment Guidelines Among Children Hospitalized With Acute COVID-19.
OBJECTIVE: COVID-19 treatment guidelines rapidly evolved during the pandemic. The December 2020 Infectious Diseases Society of America (IDSA) guideline, endorsed by the Pediatric Infectious Diseases Society, recommended steroids for critical disease, and suggested steroids and remdesivir for severe disease. We evaluated how medications for children hospitalized with COVID-19 changed after guideline publication.METHODS: We performed a multicenter retrospective cohort study of children ages 30 days to <18 years hospitalized with acute COVID-19 at 42 tertiary care US children's hospitals April 2020 - December 2021. We compared medication use before and after the December 2020 IDSA guideline (pre- and post-guideline) stratified by COVID-19 disease severity (mild-moderate, severe, critical) with interrupted time series.RESULTS: Among 18,364 patients who met selection criteria, 80.3% were discharged in the post-guideline period. Remdesivir and steroid use increased post-guideline relative to the pre-guideline period, although the trend slowed. Post-guideline, among patients with severe disease, 75.4% received steroids and 55.2% remdesivir, and in those with critical disease, 82.4% received steroids and 41.4% remdesivir. Compared to pre-guideline, enoxaparin use increased overall but decreased among patients with critical disease. Post-guideline, tocilizumab use increased and hydroxychloroquine, azithromycin, anakinra, and antibiotic use decreased. Antibiotic use remained high in severe (51.7%) and critical disease (81%).CONCLUSIONS: Although utilization of COVID-19 medications changed following December 2020 IDSA guidelines, there was a decline in uptake and incomplete adherence for children with severe and critical disease. Efforts should enhance reliable delivery of guideline-directed therapies to children hospitalized with COVID-19 and assess their effectiveness.
View details for DOI 10.1542/peds.2022-056606
View details for PubMedID 35701866
Reproducible Breath Metabolite Changes in Children with SARS-CoV-2 Infection
ACS INFECTIOUS DISEASES
2021; 7 (9): 2596-2603
SARS-CoV-2 infection is diagnosed through detection of specific viral nucleic acid or antigens from respiratory samples. These techniques are relatively expensive, slow, and susceptible to false-negative results. A rapid noninvasive method to detect infection would be highly advantageous. Compelling evidence from canine biosensors and studies of adults with COVID-19 suggests that infection reproducibly alters human volatile organic compound (VOC) profiles. To determine whether pediatric infection is associated with VOC changes, we enrolled SARS-CoV-2 infected and uninfected children admitted to a major pediatric academic medical center. Breath samples were collected from children and analyzed through state-of-the-art GCxGC-ToFMS. Isolated features included 84 targeted VOCs. Candidate biomarkers that were correlated with infection status were subsequently validated in a second, independent cohort of children. We thus find that six volatile organic compounds are significantly and reproducibly increased in the breath of SARS-CoV-2 infected children. Three aldehydes (octanal, nonanal, and heptanal) drew special attention, as aldehydes are also elevated in the breath of adults with COVID-19. Together, these biomarkers demonstrate high accuracy for distinguishing pediatric SARS-CoV-2 infection and support the ongoing development of novel breath-based diagnostics.
View details for DOI 10.1021/acsinfecdis.1c00248
View details for Web of Science ID 000696180300003
View details for PubMedID 34319698
View details for PubMedCentralID PMC8353987