Correspondence Address:
Prof. Gary W K Wong
Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT
Hong Kong

Full Text



As the world is slowly coming out from the coronavirus disease 2019 (COVID-19) pandemic, pediatricians and pediatric intensivists are facing new challenges. Young children who have been well protected from various common viral infections are now facing great danger of severe viral respiratory tract infections. Early data from New Zealand and Australia clearly showed a significant rebound of severe respiratory synctial virus infection in young children.[1],[2] In addition to respiratory synctial virus, other viral infections are coming back into the community. Asthmatics are at high risk of developing exacerbations precipitated by viral infections. In this issue, Nguyen et al.[3] reported a cross-sectional study in Vietnam demonstrating a high percentage of children with asthma exacerbations were found to have concomitant viral infections. The results are in line with results in other parts of the world. Strategies to reduce viral respiratory infections will potentially reduce asthma exacerbations in the population setting. The epidemiology of intensive care admission has experienced dramatic changes during the pandemic. Severe viral respiratory infections other than COVID-19 have decreased dramatically, whereas high rates of diabetic ketoacidosis (DKA) resulting in admission to intensive care units (ICUs) have been observed.[4],[5] Whang et al.[6] reported, in this issue, a large series of pediatric patients with ICU admission due to DKA within the period of pandemic. Interestingly, nonemergency room admission and younger age were identified as risk factors for longer ICU stay. It was likely that a delay in diagnosis was an important reason for the longer ICU stay for those transferred from other hospital wards instead of admitting directly from the emergency department where the diagnosis of DKA was made promptly. High index of suspicion is needed in order to facilitate early diagnosis of this potentially lethal condition. Pulmonary hemorrhage is an uncommon but potentially lethal condition affecting children especially for those with severe hemorrhage. Nathan et al[7] described five interesting cases of children who presented with possible pulmonary hemorrhage and discussed the diagnostic approach including the important differentiation of hemoptysis, hematemesis, or simple bleeding from the nose. I am sure readers will find these cases educational and the approach described will help them to manage future cases of possible pulmonary hemorrhage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References