Impact of the Omicron Strain on Febrile Convulsions Requiring Hospitalization in Children: A Single-Center Observational Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

congratulations to authors for this work. SARS-CoV-2  continues being nowdays a unknown virus and more and more research paper should be published. 

Minor comments:

- Explain the meanning of FA tests in the text.

-  Put some subclasification in table 1, por instance, Table 1 A, Table 1 b. or all the information in the same note as:

Table 1. Comparison of age and admission period in FC and comparison of the age and length of hospitalization in FC group between 2021 and 2022.

- although the final results are similar to other virus the authors should add in final discussion that the possibility of Multisystem Inflammatory Syndrome in Children (MIS-C) some weeks even months after a child is infected with SARS-CoV-2  should be taking account.

 

 

Author Response

To Reviewer1

 

We would like to thank you for carefully reading our paper and for your valuable advice. We will respond to each reviewer's points and explain the revised points.

 

Minor comments:

 

- Explain the meaning of FA tests in the text.

 

Following your instructions, I have added the following text. (line 133-135)

 

FA test is a method that uses multiplex nested PCR to detect multiple pathogens at once using an automatic analyzer.

 

-  Put some subclasification in table 1, por instance, Table 1 A, Table 1 b. or all the information in the same note as:

 

Regarding Table 1, the contents are simple and I think there is no need to divide it into A and B. The content of Table 1 is explained in the Result section precisely. (line 157-161)

 

Table 1. Comparison of age and admission period in FC and comparison of the age and length of hospitalization in FC group between 2021 and 2022.

 

We removed duplicate parts of table title. (line 178)

 

- although the final results are similar to other virus the authors should add in final discussion that the possibility of Multisystem Inflammatory Syndrome in Children (MIS-C) some weeks even months after a child is infected with SARS-CoV-2  should be taking account.

 

Following your instructions, I have added the following text. (line 361-367)

 

Cases of developing Multisystem Inflammatory Syndrome in Children (MIS-C) after contracting COVID-19 have been reported from Europe and America (Pediatics 2023;152(5): e2023062101), but at our institution, MIS-C has not been observed, and the number of Kawasaki disease (KD) patients which mimics MIS-C has decreased by two-thirds. (Int J Rheum Dis 2023;26(12):2592-2595)

 

Reviewer 2 Report

Comments and Suggestions for Authors

The paper Impact of the Omicron Strain on Febrile Convulsions 2 Requiring Hospitalization in children: A Single-Center 3 Observational Study is nice and readable. I would suggest a revision from a native english speaker. I not able to assess statistical analysis. Moreover i will suggest to add and comments some more detail of neurological impairment in children with SARS-CoV-2 infection. see Pavone P, Ceccarelli M, Marino S, Caruso D, Falsaperla R, Berretta M, Rullo EV, Nunnari G. SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc Health. 2021 Jun;5(6):e19-e21. doi: 10.1016/S2352-4642(21)00135-8. Epub 2021 May 4. PMID: 33961798; PMCID: PMC8096321.

 

 

Comments on the Quality of English Language

Revision from a native english speaker

Author Response

To Reviewr2

 

We would like to thank you for carefully reading our paper and for your valuable advice. We will respond to each reviewer's points and explain the revised points.

 

The paper Impact of the Omicron Strain on Febrile Convulsions 2 Requiring Hospitalization in children: A Single-Center 3 Observational Study is nice and readable. I would suggest a revision from a native english speaker. I not able to assess statistical analysis. Moreover i will suggest to add and comments some more detail of neurological impairment in children with SARS-CoV-2 infection. see Pavone P, Ceccarelli M, Marino S, Caruso D, Falsaperla R, Berretta M, Rullo EV, Nunnari G. SARS-CoV-2 related paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc Health. 2021 Jun;5(6):e19-e21. doi: 10.1016/S2352-4642(21)00135-8. Epub 2021 May 4. PMID: 33961798; PMCID: PMC8096321.

 

Following your instructions, I have added the following text. (line 357-361)

 

Neurological manifestations of COVID-19 in childhood have been described but are usually less severe than other ages (Pediarics 2020; 145: e20200702).

 

COVID-19 is also known to be related with pediatric acute-onset neuropsychiatric syndrome (PANS), which is characterized by s sudden development of neurological and psychiatric symptoms following infections (Lancet Child Adolesc Health. 2021;5(6):e19-e21, J Psychiatric Res 2019; 110: 93-102, J Child Adolesc Psychopharmacol 2019; 29: 305-312).

 

Reviewer 3 Report

Comments and Suggestions for Authors

Manuscript: Impact of the Omicron Strain on Febrile Convulsions Requiring Hospitalization in children: A Single-Center Observational Study.

 

The study addresses an interesting aspect of febrile seizures in children caused by SARS-COV-2 virus infection, particularly the Omicron variant.

However, every part of the manuscript, especially the methodology and presentation of results requires significant revision.

The study has several major limitations:

Title:  The authors state "a single center, observational study" but in the methodology, they describe using surveys from multiple centers.

Introduction - It requires presenting and justifying why such a topic was chosen. At the end, the aims of the study should be clearly described. For example, lines 88-95   contain methodology and results instead of a clearly stated research thesis.

Methodology - There is a lack of study design. The inclusion and exclusion criteria are not clearly defined. The authors compare two different time periods using different research methods. In the first, they study children admitted to one hospital over 2 years, drawing information from hospital records, while in the second, they rely on surveys from multiple institutions.

The results are presented unclearly; the tables are immature, and there is a lack of a graph showing the number of children included, and excluded from the study, and the reasons for exclusion.

Discussion - The hypotheses discovered by the authors in the study should be presented, followed by a discussion with other literature. Definitions and descriptions of seizures should be placed in other sections (introduction, methodology).

 

 In its current form, the manuscript is not suitable for acceptance. It should be revised and resubmitted  due to the interesting clinical aspect raised by the Authors.

Comments on the Quality of English Language

Sentences should be more concise and precise.

 

Author Response

To Reviewer3

 

We would like to thank you for carefully reading our paper and for your valuable advice. We will respond to each reviewer's points and explain the revised points.

 

The study addresses an interesting aspect of febrile seizures in children caused by SARS-COV-2 virus infection, particularly the Omicron variant.

 

However, every part of the manuscript, especially the methodology and presentation of results requires significant revision.

 

 

The study has several major limitations:

 

Title:  The authors state "a single center, observational study" but in the methodology, they describe using surveys from multiple centers.

 

Our study presents and discusses data from our own institution. Public data in Tokyo is cited to show that our hospital treats a relatively large number of severe cases among children infected with SARS-CoV-2. This is cited as reference material to ensure the validity of our results, and is used as material for discussion, so I think there is no problem with it.

 

Introduction - It requires presenting and justifying why such a topic was chosen. At the end, the aims of the study should be clearly described. For example, lines 88-95   contain methodology and results instead of a clearly stated research thesis.

 

This question is addressed in the introduction. (line 81-88)

 

Methodology - There is a lack of study design. The inclusion and exclusion criteria are not clearly defined. The authors compare two different time periods using different research methods. In the first, they study children admitted to one hospital over 2 years, drawing information from hospital records, while in the second, they rely on surveys from multiple institutions.

 

When discussing epidemiological data based on data from a single facility, we believe it is important to show that the data reflect the epidemiological situation of a group or region in a more or less similar manner. To this end, we compared our data with data from the entire Tokyo metropolitan area and showed that the data from our single facility was not biased. The general structure of epidemiological data in Tokyo is explained in detail in 2-2. (line 114-130)

 

The results are presented unclearly; the tables are immature, and there is a lack of a graph showing the number of children included, and excluded from the study, and the reasons for exclusion. This is generally required and I think it is a valid method.

 

The purpose of Figures 1 and 2 is to show trends, and we thought that including real numbers would make the figures complicated and difficult to read. Patient inclusion criteria are described in 2.1 of 2. Materials and Methods. The number of patients with convulsions is detailed in Table 1, and the breakdown of the number of patients with respiratory diseases is detailed in Tables 2 and 3. Result section.

 

Discussion - The hypotheses discovered by the authors in the study should be presented, followed by a discussion with other literature. Definitions and descriptions of seizures should be placed in other sections (introduction, methodology).

 

Definitions and descriptions of seizures are also described in 2-1 of Material and Methods to make it easy to understand. (line 106-107)

 

 

 In its current form, the manuscript is not suitable for acceptance. It should be revised and resubmitted  due to the interesting clinical aspect raised by the Authors.

 

 

We appreciate your review of our responses and revised versions. We sincerely hope that the revised version is satisfactory to the reviewers and deserves to be accepted.

 

 

Corresponding author:

Masayuki Nagasawa, M.D., Ph.D.,

Department of Pediatrics, Musashino Red Cross Hospital

1-26-1, Kyonan-cho, Musashino-city, Tokyo 180-8610, Japan