Browsing by Author "Fonseca, Yudy"

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    Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis
    (Frontiers Media, 2024-06-07) Kortz, Teresa B.; Mediratta, Rishi P.; Smith, Audrey M.; Nielsen, Katie R.; Agulnik, Asya; Gordon Rivera, Stephanie; Reeves, Hailey; O'Brien, Nicole F.; Hau Lee, Jan; Abbas, Qalab; Attebery, Jonah E.; Bacha, Tigist; Bhutta, Emaan G.; Biewen, Carter J.; Camacho-Cruz, Jhon; Coronado Muñoz, Alvaro; deAlmeida, Mary L.; Owusu, Larko Domeryo; Fonseca, Yudy; Hooli, Shubhada; Wynkoop, Hunter; Leimanis-Laurens, Mara; Mally, Deogratius Nicholaus; McCarthy, Amanda M.; Mutekanga, Andrew; Pineda, Carol; Remy, Kenneth E.; Sanders, Sara C.; Tabor, Erica; Teixeira Rodrigues, Adriana; Yuee Wang, Justin Qi; Kissoon, Niranjan; Takwoingi, Yemisi; Wiens, Matthew O.; Bhutta, Adnan; Pediatrics, School of Medicine
    In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%–4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9–14)]; respiratory [9 (95% CI 5–13)]; and gastrointestinal [9 (95% CI 6–11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231–280)]; infectious [214 (95% CI 193–234)]; and gastrointestinal [166 (95% CI 143–190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.
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    Prevalence of Pulmonary Embolism in COVID-19 Positive Critically Ill Children
    (Wolters Kluwer, 2025-01-15) Fonseca, Yudy; Davies, Alise; Jarrin, Stephanie; Simon, Liliana; Foster, Cortney; Kai, Sun; Bhutta, Adnan; Pediatrics, School of Medicine
    Objectives: To investigate the prevalence of pulmonary embolism (PE) in children admitted to critical care diagnosed with COVID-19 infection. Design: Retrospective database study. Setting: Data reported to the Virtual Pediatric Systems, 2018-2021. Patients: Patients 28 days to younger than 18 years old, admitted to a PICU with either PE or COVID-19 diagnoses. Interventions: None. Measurements and main results: Among the PE-positive subgroups, from January 2020 to December 2021, 78 patients (14%) had an acute COVID-19 infection. The prevalence of PE pre-pandemic period (2018-2019) was 0.19% and for pandemic period (2020-2021) was 0.26% (p < 0.001). During the pandemic period, the prevalence of PE for COVID-negative patients was 0.21% and for COVID-positive patients was 1.01% (p < 0.001). The result shows that the chance to develop PE for COVID-positive patients is 4.8 times that for COVID-negative patients during the pandemic. In the subgroup of the PE-positive patients, 55.1% were Black or African American in the COVID-positive group and 19% in the COVID-negative group (p < 0.001). A multivariable logistic regression showed that race was an independent risk factor for COVID in PE-positive patients. Conclusions: Our study demonstrates a significant increase in the prevalence of PE among pediatric patients admitted to PICUs during the COVID-19 pandemic compared with pre-pandemic. Our study indicates that COVID-positive patients are 4.8 times more likely to develop PE than COVID-negative patients. Additionally, the study highlights substantial racial disparities in the prevalence of PE, with Black or African American patients being disproportionately affected.