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Chan OW, Lee EP, Chou CC, Lai SH, Chung HT, Lee J, Lin JJ, Hsieh KS, Hsia SH. In-hospital care of children with COVID-19. Pediatr Neonatol 2024; 65:2-10. [PMID: 37989708 DOI: 10.1016/j.pedneo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 11/23/2023] Open
Abstract
Children have been reported to be less affected and to have milder severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than adults during the coronavirus disease 2019 (COVID-19) pandemic. However, children, and particularly those with underlying disorders, are still likely to develop critical illnesses. In the case of SARS-CoV-2 infection, most previous studies have focused on adult patients. To aid in the knowledge of in-hospital care of children with COVID-19, this study presents an expert review of the literature, including the management of respiratory distress or failure, extracorporeal membrane oxygenation (ECMO), multisystem inflammatory syndrome in children (MIS-C), hemodynamic and other organ support, pharmaceutical therapies (anti-viral drugs, anti-inflammatory or antithrombotic therapies) and management of cardiopulmonary arrest.
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Affiliation(s)
- Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Che Chou
- Division of Paediatric Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Shen-Hao Lai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Cardiovascular Internal Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, China
| | - Jung Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, ROC
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Sheng Hsieh
- Center of Structure and Congenital Heart Disease/Ultrasound and Department of Cardiology, Children's Hospital, China Medical University, Taichung, Taiwan; Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan.
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Foster AA, Walls TA, Alade KH, Brown K, Gausche‐Hill M, Lin SD, Rose EA, Ruttan T, Shahid S, Sorrentino A, Stoner MJ, Waseem M, Saidinejad M. Review of pediatric emergency care and the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2023; 4:e13073. [PMID: 38045015 PMCID: PMC10691296 DOI: 10.1002/emp2.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in health care delivery for patients of all ages. These included inadequate personal protective equipment, workforce shortages, and unknowns related to a novel virus. Children have been uniquely impacted by COVID-19, both from the system of care and socially. In the initial surges of COVID-19, a decrease in pediatric emergency department (ED) volume and a concomitant increase in critically ill adult patients resulted in re-deployment of pediatric workforce to care for adult patients. Later in the pandemic, a surge in the number of critically ill children was attributed to multisystem inflammatory syndrome in children. This was an unexpected complication of COVID-19 and further challenged the health care system. This article reviews the impact of COVID-19 on the entire pediatric emergency care continuum, factors affecting ED care of children with COVID-19 infection, including availability of vaccines and therapeutics approved for children, and pediatric emergency medicine workforce innovations and/or strategies. Furthermore, it provides guidance to emergency preparedness for optimal delivery of care in future health-related crises.
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Affiliation(s)
- Ashley A. Foster
- Department of Emergency MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Theresa A. Walls
- Division of Emergency Medicine, Department of PediatricsThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kiyetta H. Alade
- Division of Emergency Medicine, Department of PediatricsTexas Children's HospitalHoustonTexasUSA
| | - Kathleen Brown
- Division of Emergency Medicine, Department of PediatricsChildren's National HospitalWashington, DCUSA
| | - Marianne Gausche‐Hill
- Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
- Department of Emergency MedicineHarbor‐University of California Los Angeles Medical CenterLos AngelesCaliforniaUSA
- Department of PediatricsHarbor‐University of California Los Angeles Medical CenterLos AngelesUSA
- The Lundquist Institute for Biomedical Innovation at Harbor University of CaliforniaLos AngelesCaliforniaUSA
| | - Sophia D. Lin
- Departments of Emergency Medicine and PediatricsWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Emily A. Rose
- Department of Emergency MedicineLos Angeles County + University of Southern California Medical CenterLos AngelesCaliforniaUSA
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical SchoolThe University of Texas at AustinUS Acute Care SolutionsCantonOhioUSA
| | - Sam Shahid
- Department of Clinical AffairsAmerican College of Emergency PhysiciansIrvingTexasUSA
| | - Annalise Sorrentino
- Department of Pediatrics, Division of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael J Stoner
- Division of Emergency MedicineDepartment of PediatricsNationwide Children's HospitalColumbusOhioUSA
| | - Muhammad Waseem
- Division of Emergency MedicineLincoln Medical CenterBronxNew YorkUSA
| | - Mohsen Saidinejad
- Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
- Department of Emergency MedicineHarbor‐University of California Los Angeles Medical CenterLos AngelesCaliforniaUSA
- The Lundquist Institute for Biomedical Innovation at Harbor University of CaliforniaLos AngelesCaliforniaUSA
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Ungar SP, Solomon S, Stachel A, Shust GF, Clouser KN, Bhavsar SM, Lighter J. Hospital and ICU Admission Risk Associated With Comorbidities Among Children With COVID-19 Ancestral Strains. Clin Pediatr (Phila) 2023; 62:1048-1058. [PMID: 36661087 PMCID: PMC9895283 DOI: 10.1177/00099228221150605] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A large proportion of children have been affected by COVID-19; we evaluated the association between comorbidities and hospitalization/ICU (intensive care unit) admission among 4097 children under age 21 years with symptomatic COVID-19 (not just polymerase chain reaction [PCR]-positive or multisystem inflammatory syndrome in children associated with COVID-19 [MIS-C]) from 2 large health systems from March 2020 to September 2021. Significant comorbidities and demographic factors identified by univariable analysis were included in a multivariable logistic regression compared with children ages 6 to 11 without comorbidities. In all, 475 children (11.6%) were hospitalized, of whom 25.5% required ICU admission. Children under 1 year had high hospitalization risk, but low risk of ICU admission. Presence of at least 1 comorbidity was associated with hospitalization and ICU admission (odds ratio [OR] > 4). Asthma, obesity, chronic kidney disease, sickle cell disease, bone marrow transplantation, and neurologic disorders were associated with hospitalization (adjusted odds ratio [AOR] > 2). Malignancy, intellectual disability, and prematurity were associated with ICU admission (AOR > 4). Comorbidities are significantly associated with hospitalization/ICU admission among children with COVID-19.
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Affiliation(s)
- Stephanie P. Ungar
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, New York University Grossman School of Medicine,
New York, NY, USA
| | - Sadie Solomon
- Department of Infection Prevention and
Control, New York University Langone Health, New York, NY, USA
| | - Anna Stachel
- Department of Infection Prevention and
Control, New York University Langone Health, New York, NY, USA
| | - Gail F. Shust
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, New York University Grossman School of Medicine,
New York, NY, USA
| | - Katharine N. Clouser
- Department of Pediatrics, Hackensack
University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ,
USA
| | - Sejal M. Bhavsar
- Department of Pediatrics, Hackensack
University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ,
USA
| | - Jennifer Lighter
- Division of Pediatric Infectious
Diseases, Department of Pediatrics, New York University Grossman School of Medicine,
New York, NY, USA
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Yılmaz D, Üstündağ G, Büyükçam A, Salı E, Çelik Ü, Avcu G, Belet N, Çakmak Taşkın E, Öcal Demir S, Birbilen AZ, Kılıç Ö, Metin Akcan Ö, Tekin Yılmaz A, Aldemir Kocabaş B, Hatipoğlu N, Karbuz A, Çakır D, Sütçü M, Aygün FD, Çelik T, Bayturan Şen S, Dalgıç N, Ümit Z, Kara SS, Karadağ Öncel E, Bolat A, Kılıç Çil M, Turan C, Çakıl Güzin A, Topal S, Esen Besli G, Doğan G, Şahin S, Akın F, Bildirici Y, Timurtaş Dayar G, Ergül Sarı E, Kızmaz İşançlı D, Kara M, Önal P, Aylaç H, Lüleci D, Yaşar B, Dede E, Çağlar A, Akova S, Afat Turgut E, Yazıcı Özkaya P, Kandemir Gülmez T, Ulusoy E, Duyu M, Kara Y, Çeliktaş H, Tekeli O, Çağlar F, Gül D, Oral Cebeci S, Battal F, Bal A, Aygün E, Uysalol M, Arslan G, Özkavaklı A, Kızıl MC, Yazar A, Aygün F, Somer A, Kuyucu N, Dinleyici EÇ, Kara A. A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey. Eur J Pediatr 2023:10.1007/s00431-023-04982-6. [PMID: 37140703 PMCID: PMC10157577 DOI: 10.1007/s00431-023-04982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027). Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.
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Affiliation(s)
- Dilek Yılmaz
- Department of Pediatric Infectious Diseases, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Gülnihan Üstündağ
- Pediatric Infectious Disease Clinic, Health Science University İzmir Tepecik Training and Research Hospital, Konak 35020, İzmir, Turkey.
| | - Ayşe Büyükçam
- Pediatric Infectious Disease Clinic, Health Science University Gülhane Training and Research Hospital, Ankara, Turkey
| | - Enes Salı
- Pediatric Infectious Disease Clinic, Health Science University Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ümit Çelik
- Pediatric Infectious Disease Clinic, Adana City Hospital, Adana, Turkey
| | - Gülhadiye Avcu
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Nurşen Belet
- Department of Pediatric Infectious Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Esra Çakmak Taşkın
- Pediatric Infectious Disease Clinic, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Sevliya Öcal Demir
- Pediatric Infectious Disease Clinic, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ahmet Ziya Birbilen
- Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Pediatric Emergency Clinic, Gaziantep, Turkey
| | - Ömer Kılıç
- Department of Pediatric Infectious Diseases, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özge Metin Akcan
- Department of Pediatric Infectious Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ayşe Tekin Yılmaz
- Pediatric Infectious Disease Clinic, Eskişehir City Hospital, Eskişehir, Turkey
| | - Bilge Aldemir Kocabaş
- Pediatric Infectious Disease Clinic, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Nevin Hatipoğlu
- Pediatric Infectious Disease Clinic, Health Science University İstanbul Bakırköy Doctor Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Adem Karbuz
- Pediatric Infectious Disease Clinic, Cemil Taşçıoğlu City Hospital, İstanbul Prof. Dr, Istanbul, Turkey
| | - Deniz Çakır
- Pediatric Infectious Disease Clinic, Health Science University Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Sütçü
- Department of Pediatric Infectious Diseases, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Deniz Aygün
- Department of Pediatric Infectious Diseases, Cerrahpaşa University Faculty of Medicine, Istanbul, Turkey
| | - Taylan Çelik
- Department of Pediatric Infectious Diseases, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Semra Bayturan Şen
- Department of Pediatric Infectious Diseases, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Nazan Dalgıç
- Pediatric Infectious Disease Clinic, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Zühal Ümit
- Pediatric Infectious Disease Clinic, Manisa City Hospital, Manisa, Turkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Eda Karadağ Öncel
- Pediatric Infectious Disease Clinic, Health Science University İzmir Tepecik Training and Research Hospital, Konak 35020, İzmir, Turkey
| | - Ahmet Bolat
- Pediatrics Clinic, Health Science University Gülhane Training and Research Hospital, Ankara, Turkey
| | - Merve Kılıç Çil
- Pediatric Infectious Disease Clinic, Adana City Hospital, Adana, Turkey
| | - Caner Turan
- Department of Pediatric Emergency Medicine, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Çakıl Güzin
- Department of Pediatric Infectious Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sevgi Topal
- Pediatric Intensive Care Unit, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gülser Esen Besli
- Pediatric Emergency Clinic, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Gizem Doğan
- Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Pediatrics Clinic, Gaziantep, Turkey
| | - Sabiha Şahin
- Department of Pediatric Emergency Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Fatih Akın
- Department of Pediatrics, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Yaşar Bildirici
- Pediatrics Clinic, Eskişehir City Hospital, Eskişehir, Turkey
| | - Gülperi Timurtaş Dayar
- Pediatric Infectious Disease Clinic, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Emine Ergül Sarı
- Pediatrics Clinic, Health Science University İstanbul Bakırköy Doctor Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Didem Kızmaz İşançlı
- Pediatric Infectious Disease Clinic, Cemil Taşçıoğlu City Hospital, İstanbul Prof. Dr, Istanbul, Turkey
| | - Manolya Kara
- Department of Pediatric Infectious Diseases, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Pınar Önal
- Department of Pediatric Infectious Diseases, Cerrahpaşa University Faculty of Medicine, Istanbul, Turkey
| | - Hakan Aylaç
- Department of Pediatrics, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Duygu Lüleci
- Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Belma Yaşar
- Pediatric Infectious Disease Clinic, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Elif Dede
- Department of Pediatric Infectious Diseases, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Aykut Çağlar
- Department of Pediatric Emergency Medicine , Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Sevgi Akova
- Pediatric Emergency Clinic, Health Science University Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Elif Afat Turgut
- Pediatric Infectious Disease Clinic, Adana City Hospital, Adana, Turkey
| | - Pınar Yazıcı Özkaya
- Department of Pediatric Intensive Care, Ege University Faculty of Medicine, İzmir, Turkey
| | | | - Emel Ulusoy
- Department of Pediatric Emergency Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Muhterem Duyu
- Pediatric Intensive Care Unit, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Yalçın Kara
- Department of Pediatric Infectious Diseases, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Hüseyin Çeliktaş
- Department of Pediatrics, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Onur Tekeli
- Pediatric Infectious Disease Clinic, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatma Çağlar
- Pediatric Emergency Clinic, Health Science University İstanbul Bakırköy Doctor Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Doruk Gül
- Department of Pediatrics, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Sinem Oral Cebeci
- Department of Pediatric Emergency Medicine, Cerrahpaşa University Faculty of Medicine, Istanbul, Turkey
| | - Fatih Battal
- Department of Pediatrics, Çanakkale 18 Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Alkan Bal
- Department of Pediatric Emergency Medicine, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Emre Aygün
- Pediatrics Clinic, Health Science University Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Metin Uysalol
- Department of Pediatric Emergency Medicine, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ayberk Özkavaklı
- Pediatrics Clinic, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Mahmut Can Kızıl
- Department of Pediatric Infectious Diseases, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Abdullah Yazar
- Department of Pediatrics, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Fatih Aygün
- Department of Pediatric Intensive Care, Cerrahpaşa University Faculty of Medicine, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Necdet Kuyucu
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ener Çağrı Dinleyici
- Department of Pediatric Intensive Care, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Al-Khlaifat AM, Al Quraan AM, Nimri AF, Khaled NEB, Ramadina N, Ayyash FF, Daoud SO, Hamlan SY, Hababeh BM. Factors Influencing the Length of Hospital Stay Among Pediatric COVID-19 Patients at Queen Rania Al Abdullah Hospital for Children: A Cross-Sectional Study. Cureus 2023; 15:e35000. [PMID: 36949998 PMCID: PMC10027108 DOI: 10.7759/cureus.35000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Background COVID-19 caused by SARS-CoV-2 is a worldwide epidemic. Children are less commonly infected and have less severe symptoms than adults. However, they are at risk for COVID-19-associated severe sickness and hospitalization. The duration of stay is a major driver of effective health treatment during hospitalization; thus, it is only logical to attempt to comprehend the factors influencing the length of stay (LOS) for these patients, particularly in light of the ongoing pandemic caused by the new SARS-CoV-2 virus. As predictors of hospital LOS, several variables, including age, gender, disease severity, hospital mortality, insurance type, and hospital location, have been discovered. In our study, we focused on the severity of the patient's condition, the presence of comorbidities, and the necessary therapeutic regimen to predict the duration of stay. This study aimed to answer the following questions: If a patient has comorbidity and has COVID-19 requiring hospital treatment, will the patient's comorbidity elongate the duration of stay at the hospital for further management in the pediatric age group? What are the risk factors that play a significant role in the hospital stay duration in pediatrics? Methodology We gathered data from 100 hospitalized children aged up to 14 years who tested positive for COVID-19, which was not specific to variants of SARS-CoV-2, over 24 months (February 2020-February 2022) at Queen Rania Al Abdullah Hospital for Children, one of the Health Care Accreditation Council accredited facilities. Clinical symptoms, signs, oxygen demand, imaging study results, laboratory data, and usage of corticosteroid and antiviral medication were all taken from patients' medical records. There were no limitations in taking the sample of patients. All patients in the duration mentioned were included. Results Clinical data of 100 COVID-19-positive pediatric patients were analyzed; 52% of the patients had associated chronic illnesses, while 48% were medically free. The longest duration of LOS was 28 days, the shortest was one day, the median was eight days, and five days was the most frequent among patients owing to 21% of patients, using mean descriptive statistics. We compared LOS to having or not having comorbidities. The mean LOS of patients with the comorbid disease was 6.15 days, with a maximum of 28 days, while for patients without chronic illnesses, the mean was 4.81 days with a maximum of 14 days. The significance was 0.07. Our results also showed a significant correlation between using steroids and LOS, as it had an advantageous effect by decreasing it with a significance value of 0.04. Having abnormal findings on chest computed tomography (CT) scan was also associated with increased LOS with a significant value of 0.00. Conclusions According to our research, there was no direct association between comorbidity and hospital LOS, which is counterintuitive, as it was influenced by multiplayers of variables such as using steroids, which decreased the LOS, and abnormal findings on chest CT, which resulted in lengthening of the hospital stay. Our findings cannot be proven without further research and a larger patient sample.
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Affiliation(s)
- Alia M Al-Khlaifat
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Amman, JOR
| | - Asmaa M Al Quraan
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aseel F Nimri
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Amman, JOR
| | | | | | - Fadi F Ayyash
- Pediatric Endocrinology, Jordanian Royal Medical Services, Amman, JOR
| | - Shadi O Daoud
- Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Sarah Y Hamlan
- Pediatrics, Jordanian Royal Medical Services, Amman, JOR
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6
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Ling KM, Dougan M. Monoclonal antibodies for the treatment of COVID-19 infection in children. Expert Rev Anti Infect Ther 2022; 20:1529-1535. [PMID: 36225144 DOI: 10.1080/14787210.2022.2134117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Monoclonal antibodies (mAbs) have been authorized for the treatment of COVID-19 in pediatric populations, however, there is a lack of evidence for their use in these populations. AREAS COVERED We outline the evidence of mAbs for COVID-19, discuss their use in the treatment of COVID-19 infection for pediatric patients, and consider alternative treatment options and challenges to COVID-19 drug approvals. EXPERT OPINION Limited evidence exists for the safety and efficacy of mAbs to treat COVID-19 in children as new variants emerge. In rare pediatric outpatient settings, such as profound immunodeficiency or severe pulmonary disease, the benefits of antiviral treatment for COVID-19 likely outweigh the relatively small risks. However, for the great majority of pediatric patients, mAb treatment is likely not indicated. Small molecule antiviral therapies are another potential treatment for COVID-19 in children in an outpatient setting, though neither mAb nor small molecule antiviral treatments have significant supporting evidence in children and developing a strong evidence base for these decisions will be challenging if not impractical. Ultimately, these decisions are likely to be made at the level of individual cases using expert opinion as the primary guiding principle.
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Affiliation(s)
- Kelly M Ling
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Dougan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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7
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Diaz DR, Urrutia S, Gutierrez G, Cuevas F. Clinical presentation and outcomes of hospitalized children with COVID-19 in Mexico City. Pediatr Pulmonol 2022; 57:3044-3049. [PMID: 36039829 PMCID: PMC9538333 DOI: 10.1002/ppul.26132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/22/2022] [Accepted: 08/06/2022] [Indexed: 01/11/2023]
Abstract
We describe the demographic, clinical, radiological, and laboratory findings relating them also to the severity and clinical outcome of 129 children (0-18 years) who were admitted to a tertiary care pediatric hospital in Mexico City due to severe acute respiratory syndrome coronavirus 2 infection between April 1, 2020 and March 31, 2021. The infection was confirmed using reverse transcription-polymerase chain reaction Fever (82.2%), tachypnea (72.1%), and cough (71.3%) were the most reported signs at the moment of hospitalization. The most frequent radiological pattern that stood out was the interstitial pattern (66.7%). History of oncologic pathology (25.6%) was the most frequent past medical history. Non-steroidal anti-inflammatory drugs (93%), antibiotics (57.4%), and steroids (40.3%) were the most common medication given. The average hospitalization stay was 14.2 days, and 21.7% of the total patients required transfer to the intensive care unit. At discharge, 20.2% required oxygen on an outpatient basis, and unfortunately, 7.0% of the patients who were admitted to the institute for COVID-19 died. Our findings confirm that COVID-19 in children has a mild presentation except for patients with hematologic/oncologic comorbidities who had severe presentations.
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Affiliation(s)
- David R Diaz
- Department of Pediatric Pulmonology, Instituto Nacional de Pediatría, Coyoacan, Mexico
| | - Samuel Urrutia
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Gutierrez
- Department of Pediatric Pulmonology, Instituto Nacional de Pediatría, Coyoacan, Mexico
| | - Francisco Cuevas
- Department of Pediatric Pulmonology, Instituto Nacional de Pediatría, Coyoacan, Mexico
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8
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Choi SH, Choi JH, Yun KW. Therapeutics for the treatment of coronavirus disease 2019 in children and adolescents. Clin Exp Pediatr 2022; 65:377-386. [PMID: 35760410 PMCID: PMC9348956 DOI: 10.3345/cep.2022.00458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a mild to moderate respiratory illness in most children and adolescents, but a small proportion develop severe or critical illness. Although pediatric clinical trials for the treatment of COVID-19 are sparse, there are some available drugs for children and adolescents with severe COVID-19. This review summarizes clinical data focusing on antiviral agents and immunomodulators for COVID-19 treatment. Additionally, the current recommendations for therapeutics for children and adolescents with COVID-19 are discussed. Remdesivir is suggested for pediatric patients with COVID-19 in the following cases: children and adolescents with severe COVID-19 who need supplemental oxygen without mechanical ventilation; adolescents aged ≥12 years and weight of at least 40 kg with COVID-19 who do not require supplemental oxygen and are within 7 days of symptom onset and are at high risk of progression to severe illness. Nirmatrelvir/ritonavir is considered for adolescents aged ≥12 years and weighing at least 40 kg who do not require supplemental oxygen and are within 5 days of symptom onset and are at high risk of progression to severe disease. Corticosteroids are not recommended in children and adolescents with mild to moderate COVID-19. Corticosteroids are recommended in children and adolescents with severe to critical COVID-19.
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Affiliation(s)
- Soo-Han Choi
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | - Jae Hong Choi
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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9
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Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Calvo Rey P, Bouza E. COVID in Pediatric Age: an opinion paper. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:333-343. [PMID: 35287259 PMCID: PMC9333119 DOI: 10.37201/req/012.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/12/2022] [Indexed: 11/23/2022]
Abstract
The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and the scarcity of diagnostic tests applied to this population. It is now accepted that children are infected and transmit the disease in the same way as adults. On the contrary, children have less severe and less lethal COVID, probably due to a lower maturity of the child's immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this population group. The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensive care. Other less severe post-COVID manifestations have been described in children but are not yet well defined. COVID has had and continues to have a significant psychological impact on the children themselves, on their caregivers and on the exacerbation of pre-existing psychiatric conditions. We apply adult therapeutic principles to children but with very low levels of evidence. Information on the tolerability of the available medications in this population group is still scarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities. There are, at present, three vaccines licensed for pediatric use which are compatible with all other vaccines applicable to children. In these circumstances, there has been much speculation about the indication for vaccination in the pediatric age group, but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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10
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Bozkurt B, Das SR, Addison D, Gupta A, Jneid H, Khan SS, Koromia GA, Kulkarni PA, LaPoint K, Lewis EF, Michos ED, Peterson PN, Turagam MK, Wang TY, Yancy CW. 2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards. J Am Coll Cardiol 2022; 80:388-465. [PMID: 35753858 PMCID: PMC9222652 DOI: 10.1016/j.jacc.2022.03.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Bozkurt B, Das SR, Addison D, Gupta A, Jneid H, Khan SS, Koromia GA, Kulkarni PA, LaPoint K, Lewis EF, Michos ED, Peterson PN, Turagam MK, Wang TY, Yancy CW. 2022 AHA/ACC Key Data Elements and Definitions for Cardiovascular and Noncardiovascular Complications of COVID-19: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards. Circ Cardiovasc Qual Outcomes 2022; 15:e000111. [PMID: 35737748 PMCID: PMC9297692 DOI: 10.1161/hcq.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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12
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children generally have milder presentations, but severe disease can occur in all ages. MIS-C and persistent post-acute COVID-19 symptoms can be experienced by children with previous infection and emphasize the need for infection prevention. Optimal treatment for COVID-19 is not known, and clinical trials should include children to guide therapy. Vaccines are the best tool at preventing infection and severe outcomes of COVID-19. Children suffered disproportionately during the pandemic not only from SARS-CoV-2 infection but because of disruptions to daily life, access to primary care, and worsening income inequalities.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356423, Seattle, WA 98195, USA.
| | - Janet A Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, 4800 Sand Point Way NE - MA7.234, Seattle, WA 98105, USA
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13
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Schuster JE, Halasa NB, Nakamura M, Levy ER, Fitzgerald JC, Young CC, Newhams MM, Bourgeois F, Staat MA, Hobbs CV, Dapul H, Feldstein LR, Jackson AM, Mack EH, Walker TC, Maddux AB, Spinella PC, Loftis LL, Kong M, Rowan CM, Bembea MM, McLaughlin GE, Hall MW, Babbitt CJ, Maamari M, Zinter MS, Cvijanovich NZ, Michelson KN, Gertz SJ, Carroll CL, Thomas NJ, Giuliano JS, Singh AR, Hymes SR, Schwarz AJ, McGuire JK, Nofziger RA, Flori HR, Clouser KN, Wellnitz K, Cullimore ML, Hume JR, Patel M, Randolph AG. A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020. J Pediatric Infect Dis Soc 2022; 11:191-198. [PMID: 35022779 PMCID: PMC8807297 DOI: 10.1093/jpids/piab123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unclear how acute coronavirus disease 2019 (COVID-19)-directed therapies are used in children with life-threatening COVID-19 in US hospitals. We described characteristics of children hospitalized in the intensive care unit or step-down unit (ICU/SDU) who received COVID-19-directed therapies and the specific therapies administered. METHODS Between March 15, 2020 and December 27, 2020, children <18 years of age in the ICU/SDU with acute COVID-19 at 48 pediatric hospitals in the United States were identified. Demographics, laboratory values, and clinical course were compared in children who did and did not receive COVID-19-directed therapies. Trends in COVID-19-directed therapies over time were evaluated. RESULTS Of 424 children in the ICU/SDU, 235 (55%) received COVID-19-directed therapies. Children who received COVID-19-directed therapies were older than those who did not receive COVID-19-directed therapies (13.3 [5.6-16.2] vs 9.8 [0.65-15.9] years), more had underlying medical conditions (188 [80%] vs 104 [55%]; difference = 25% [95% CI: 16% to 34%]), more received respiratory support (206 [88%] vs 71 [38%]; difference = 50% [95% CI: 34% to 56%]), and more died (8 [3.4%] vs 0). Of the 235 children receiving COVID-19-directed therapies, 172 (73%) received systemic steroids and 150 (64%) received remdesivir, with rising remdesivir use over the study period (14% in March/April to 57% November/December). CONCLUSION Despite the lack of pediatric data evaluating treatments for COVID-19 in critically ill children, more than half of children requiring intensive or high acuity care received COVID-19-directed therapies.
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Affiliation(s)
- Jennifer E Schuster
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mari Nakamura
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily R Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie C Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cameron C Young
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Margaret M Newhams
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Florence Bourgeois
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary A Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Charlotte V Hobbs
- Division of Disease, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Heda Dapul
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children’s Hospital, New York, New York, USA
| | - Leora R Feldstein
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley M Jackson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tracie C Walker
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aline B Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
| | - Laura L Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston, Texas, USA
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwenn E McLaughlin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Christopher J Babbitt
- Division of Pediatric Critical Care, Department of Pediatrics, Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California, USA
| | - Mia Maamari
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Health Medical Center, Dallas, Texas, USA
| | - Matt S Zinter
- Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, California, USA
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, California, USA
| | - Kelly N Michelson
- Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shira J Gertz
- Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Christopher L Carroll
- Division of Critical Care, Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | - Neal J Thomas
- Department of Pediatrics, Penn State Hershey Children’s Hospital, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - John S Giuliano
- Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aalok R Singh
- Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Saul R Hymes
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, New York, USA
| | - Adam J Schwarz
- Division of Critical Care Medicine, CHOC Children’s Hospital, Orange, California, USA
| | - John K McGuire
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital and the University of Washington, Seattle, Washington, USA
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Akron Children’s Hospital, Akron, Ohio, USA
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children’s Hospital and University of Michigan, Ann Arbor, Michigan, USA
| | - Katharine N Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melissa L Cullimore
- Division of Pediatric Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, Nebraska, USA
| | - Janet R Hume
- Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA
| | - Manish Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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14
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Jone PN, John A, Oster ME, Allen K, Tremoulet AH, Saarel EV, Lambert LM, Miyamoto SD, de Ferranti SD. SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e1037-e1052. [PMID: 35400169 DOI: 10.1161/cir.0000000000001064] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.
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15
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Verheijen AC, Janssen EER, van der Putten ME, van Horck MWP, van Well GTJ, Van Loo IHM, Hütten MC, Van Mechelen K. Management of severe neonatal respiratory distress due to vertical transmission of severe acute respiratory syndrome coronavirus 2: a case report. J Med Case Rep 2022; 16:140. [PMID: 35346370 PMCID: PMC8958934 DOI: 10.1186/s13256-022-03364-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Neonates with severe acute respiratory syndrome coronavirus 2 infection are usually asymptomatic or have mild to moderate symptoms. Acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 with respiratory insufficiency is rare. Therefore, information about the best intensive care strategy for neonates requiring mechanical ventilation is lacking. We report a neonatal case of severe acute respiratory distress syndrome, probably due to vertical transmission of severe acute respiratory syndrome coronavirus 2, complicated by Staphylococcus aureus sepsis. We aim to inform pediatric providers on the clinical course and acute management considerations in coronavirus disease-related neonatal acute respiratory distress syndrome. Case presentation A late preterm (gestational age 36 0/7 weeks) Caucasian girl was born from a severe acute respiratory syndrome coronavirus 2-positive mother and tested positive for severe acute respiratory syndrome coronavirus 2 at 19 hours after birth. She developed acute respiratory distress syndrome requiring intensive care admission and mechanical ventilation. The clinical course was complicated by S. aureus pneumonia and bacteremia. Multimodal management included well-established interventions for respiratory distress syndrome such as surfactant therapy, high-frequency oscillatory ventilation, and inhaled nitric oxide, combined with therapies extrapolated from adult care for severe acute respiratory syndrome coronavirus 2 patients such as dexamethasone, coronavirus disease 2019-specific immunoglobins, and prophylactic low-molecular-weight heparin. The neonate was successfully weaned from the ventilator and improved clinically. Conclusion This case shows a rare but serious neonatal severe acute respiratory syndrome coronavirus 2 infection, leading to severe acute respiratory distress syndrome. Because of limited therapy guidelines for neonates, we suggest multimodal management with awareness of the possibility of S. aureus coinfection, to treat this age group successful.
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16
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Youssry I, Abd Elaziz D, Ayad N, Eyada I. The Cause–Effect Dilemma of Hematologic Changes in COVID-19: One Year after the Start of the Pandemic. Hematol Rep 2022; 14:95-102. [PMID: 35466178 PMCID: PMC9036247 DOI: 10.3390/hematolrep14020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/19/2022] [Accepted: 03/24/2022] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a systemic infection that leads to multisystem affection, including hematological changes. On the other hand, the patients who have certain hematological diseases are more susceptible to COVID-19 infection. The aim of this review is to examine the wide spectrum of hematological changes that are reported to occur due to COVID-19 infection. Most of the studies over the past year mainly show that most of these changes are mainly non-specific, but are of prognostic value. On the other hand, the susceptibility of hematological patients to COVID-19 infection and complications remains questionable. Patients with certain hematological diseases (including malignancy) and those who are treated by aggressive immunosuppressive therapy have shown higher rates of COVID-19 infection and complications. On the other hand, for most of the patients suffering from other chronic hematological conditions, no evidence has shown a greater risk of infection, compared to the general population.
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Affiliation(s)
- Ilham Youssry
- Pediatric Hematology and BMT Unit, Cairo University, Giza 12613, Egypt;
| | - Dalia Abd Elaziz
- Pediatric Department, Faculty of Medicine, Cairo University, Giza 12211, Egypt; (D.A.E.); (I.E.)
| | - Nardeen Ayad
- Pediatric Hematology and BMT Unit, Cairo University, Giza 12613, Egypt;
- Correspondence:
| | - Iman Eyada
- Pediatric Department, Faculty of Medicine, Cairo University, Giza 12211, Egypt; (D.A.E.); (I.E.)
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17
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Gatti E, Piotto M, Lelii M, Pensabene M, Madini B, Cerrato L, Hassan V, Aliberti S, Bosis S, Marchisio P, Patria MF. Therapeutic Strategies for COVID-19 Lung Disease in Children. Front Pediatr 2022; 10:829521. [PMID: 35321012 PMCID: PMC8936419 DOI: 10.3389/fped.2022.829521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has milder presentation in children than in adults, mostly requiring only supportive therapy. The immunopathogenic course of COVID-19 can be divided in two distinct but overlapping phases: the first triggered by the virus itself and the second one by the host immune response (cytokine storm). Respiratory failure or systemic involvement as Multisystem Inflammatory Syndrome in Children (MIS-C) requiring intensive care are described only in a small portion of infected children. Less severe lung injury in children could be explained by qualitative and quantitative differences in age-related immune response. Evidence on the best therapeutic approach for COVID-19 lung disease in children is lacking. Currently, the approach is mainly conservative and based on supportive therapy. However, in hospitalized children with critical illness and worsening lung function, antiviral therapy with remdesivir and immunomodulant treatment could be considered the "therapeutic pillars."
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Affiliation(s)
| | | | - Mara Lelii
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Università Degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Woolf NT. The Current Role for Biologic Medications in the Treatment of Pediatric COVID-19 and MIS-C. Pediatr Ann 2022; 51:e57-e62. [PMID: 35156889 DOI: 10.3928/19382359-20220114-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) are characterized by hyperinflammation and multiorgan dysfunction. Although the incidence and mortality of these illnesses are low in the pediatric population, they occur with enough frequency to necessitate well-defined treatment strategies with demonstrated clinical efficacy. Biologic medications include small molecules or monoclonal antibodies that target specific receptors, enzymes or other proteins that play key roles in human disease. Biologic medications that inhibit proinflammatory cytokines and signaling pathways represent an emerging and valuable tool for the treatment of both severe COVID-19 and MIS-C in pediatric patients. This article discusses current theories regarding the pathogenesis of both diseases, and it will summarize the latest evidence supporting each biologic medication used for their treatment. [Pediatr Ann. 2022;51(2):e57-e62.].
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19
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Solanki R, Gupta A, Roy S, Pal S, Khan MF. The " After Wave": Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 in a series of children from Eastern India. Med J Armed Forces India 2021; 78:S133-S138. [PMID: 34931107 PMCID: PMC8674121 DOI: 10.1016/j.mjafi.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background The objective of the study is to describe the presentation, treatment and outcomes of children with multisystem inflammatory syndrome with COVID-19 (MIS-C) in a tertiary care centre in Eastern India. Methods Retrospective data of children diagnosed with MIS-C during the SARS CoV-2 pandemic were obtained from hospital records. Clinical details, laboratory profile, treatment protocol and outcomes of children with MIS-C between 01 Nov 2020 and 30 June 2021 were analysed. Results Ten children (7 males) with a mean age of 6.8 years (median age 5.5 years, interquartile range 3.75-9.5) were analysed. COVID-19 RT-PCR was negative in all patients, whereas the IgG COVID antibody was positive in all children (100%). Seven children (7/10) had a history of contact with SARS CoV-2–positive adults. Five (5/10) children presented with cardiogenic shock. All children had evidence of a hyperinflammatory syndrome. Nine children (9/10) had predominant gastrointestinal and cardiovascular involvement. None had echocardiographic evidence of coronary dilatation or aneurysms either on admission or on follow-up. The elevated neutrophil lymphocyte ratio and D-dimer were found in all patients. All children responded to immunomodulatory treatment. None had residual deficit on discharge or at 4-week follow-up. There was no mortality. Conclusion Children with MIS-C have good prognosis if early immunomodulatory treatment is instituted. Further prospective studies for long-term outcomes in children with MIS-C are required it being a novel entity recently described.
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Affiliation(s)
- Reema Solanki
- Classified Specialist (Pediatrics), Command Hospital (Eastern Command), Kolkata, India
| | - Aparajita Gupta
- Classified Specialist (Pediatrics) & Pediatric Neurologist, Command Hospital (Eastern Command), Kolkata, India
| | - Shuvendu Roy
- Senior Advisor & Head (Pediatrics), Command Hospital (Eastern Command), Kolkata, India
| | - Sunandan Pal
- Resident (Paediatrics), Command Hospital (Eastern Command), Kolkata, India
| | - Mohd Faisal Khan
- Specialist Medical Officer, 181 Military Hospital, C/o 99 APO, India
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20
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Guimarães D, Pissarra R, Reis-Melo A, Guimarães H. Multisystem inflammatory syndrome in children (MISC): A systematic review. Int J Clin Pract 2021; 75:e14450. [PMID: 34105843 DOI: 10.1111/ijcp.14450] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to analyse current literature and reported cases of multisystem inflammatory syndrome in children (MISC), concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes. METHODS Extensive literature research was performed in MEDLINE (through PubMed), Scopus and Web of Science from December 2019 to December 2020. First analysis included all article titles and abstracts screening to identify relevant studies, and second analysis included a full-text screening of previously selected studies. Eligibility was assessed independently by two authors, and disagreements were resolved by discussion and consensus. Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis and imaging, therapeutical approach and outcomes. RESULTS Common symptoms included gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki disease were identified including age, clinical presentation and cardiac involvement. Thirty per cent presented positive severe acute respiratory syndrome coronavirus-2 reverse transcription polymerase chain reaction and 51% positive serologies. Sixty-two per cent received intravenous immunoglobulin and 42% glucocorticoids. Sixty-two per cent required intensive care and 21 children died (<2%). Severe presentations were associated with neurological symptoms, hepatitis and acute kidney injury. CONCLUSIONS MISC raises concern on its severe cardiac involvement at presentation, with frequent intensive care and immunomodulatory therapy need. Short-term outcomes seem to be favourable, with cardiac dysfunction recovery and low mortality rates.
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Affiliation(s)
| | - Rita Pissarra
- Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Reis-Melo
- Faculty of Medicine, University of Porto, Porto, Portugal
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
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21
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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22
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Jo YH, Hwang Y, Choi SH. A Case Report for Severe COVID-19 in a 9-Year-Old Child Treated with Remdesivir and Dexamethasone. J Korean Med Sci 2021; 36:e203. [PMID: 34313036 PMCID: PMC8313394 DOI: 10.3346/jkms.2021.36.e203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/11/2021] [Indexed: 11/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is generally milder in children than in adults, and a substantial proportion of children with the disease have asymptomatic infections. Remdesivir is recommended for severe COVID-19. To date, there are little data on the outcomes of remdesivir treatment in children. We report a case of severe COVID-19 in a previously healthy but obese (body mass index, 27.6; 99.8th percentile of the age) 9-year-old boy treated with remdesivir and dexamethasone. The patient had pneumonia at the time of diagnosis and required supplemental oxygen due to hypoxia one day after diagnosis. The patient developed respiratory distress as his pneumonia progressed rapidly. Therefore, remdesivir with dexamethasone therapy was initiated on hospital day 2. Supplemental oxygen was gradually weaned on hospital day 6 and stopped on hospital day 9. Significant improvement in pneumonic consolidations on chest X-ray was noted on hospital day 8. The patient was discharged on hospital day 21. We did not observe any adverse effects of remdesivir therapy and successfully treated a 9-year-old child with severe COVID-19.
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Affiliation(s)
- Yoon Hee Jo
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Yosub Hwang
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Soo Han Choi
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
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23
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Macias-Parra M, Fortes-Gutierrez S, Aguilar-Gomez N, Diaz-Garcia L, Otero-Mendoza F, Arias de la Garza E, Ordoñez-Ortega J, Palacios-Reyes D, Diaz-Jimenez IV, Serrano-Sierra A, Xochihua-Díaz L, Saltigeral-Simental P. Clinical and Epidemiological Characteristics of Paediatric Patients Diagnosed with COVID-19 in a Tertiary Hospital in Mexico City. J Trop Pediatr 2021; 67:6313144. [PMID: 34213541 DOI: 10.1093/tropej/fmab025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
COVID-19 affects the paediatric population less frequently than adults. A retrospective study was performed in a tertiary paediatric hospital in Mexico City in children <18 years of age who were hospitalized with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2. Included in the study were 86 patients with a median age of 10 years old (IQR 2.6-14.3 years), who were classified in three groups: previously healthy, with chronic disease and immunosuppressed patients. The principal signs and symptoms were fever (81%), cough (51%) and headache (35%). A total of 20 patients (23%) required management in the paediatric intensive care unit (PICU) and 17% needed mechanical ventilation for an average of 12.7 days (IQR 2-29 days). There was no statistically significant difference between the three clinical classification groups in those patients admitted to the PICU, most of which were previously healthy patients. The mortality rate was 5% (four patients). Given that the paediatric population is susceptible to infection, potential transmitters and to clinical presentations with variable degrees of severity, it is important to continue reinforcing social distancing measures.
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Affiliation(s)
- Mercedes Macias-Parra
- Medical Director, Instituto Nacional de Pediatría, National Pediatrics Institute, Insurgentes Cuicuilco, Coyoacán, Mexico City, CP 04530, Mexico
| | - Sofia Fortes-Gutierrez
- Pediatric Infectious Disease Department, National Pediatrics Institute, Mexico City, Mexico
| | - Nancy Aguilar-Gomez
- Pediatric Infectious Disease Department, National Pediatrics Institute, Mexico City, Mexico
| | - Luisa Diaz-Garcia
- Research and Methodology Department, National Pediatrics Institute, Mexico City, Mexico
| | | | | | - Javier Ordoñez-Ortega
- Pediatric Infectious Disease Department, National Pediatrics Institute, Mexico City, Mexico
| | - Debora Palacios-Reyes
- Pediatric Infectious Disease Department, National Pediatrics Institute, Mexico City, Mexico
| | | | | | - Luis Xochihua-Díaz
- Pediatric Infectious Disease Department, National Pediatrics Institute, Mexico City, Mexico
| | - Patricia Saltigeral-Simental
- Medical Director, Instituto Nacional de Pediatría, National Pediatrics Institute, Insurgentes Cuicuilco, Coyoacán, Mexico City, CP 04530, Mexico
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24
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Damania R, Moore W, Viamonte HC, Kamat P, Basu RK. Severe acute respiratory syndrome coronavirus 2 infection and critically ill children. Curr Opin Pediatr 2021; 33:286-291. [PMID: 33938473 DOI: 10.1097/mop.0000000000001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Amidst an ongoing pandemic, the delineation of the pediatric consequence of infection from the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus is emerging. This review summarizes available pediatric data and covers the aspects of epidemiology, critical illness with acute infection [coronavirus disease 2019 (COVID-19)], the discovered multi-inflammatory syndrome in children (MIS-C), and management options. RECENT FINDINGS The available data from the source of the initial viral transmission and then through Europe, Africa, and the Western Hemisphere identifies important aspects of the SARS-CoV2 pandemic: 1) Pediatric infection occurs commonly, is likely underestimated, and transmission patterns remain incompletely described, 2) Pediatric patients suffer multiple end-organ injuries but COVID-19 is not the same prevalence in terms of severity as in adults, 3) MIS-C is a novel and life-threatening manifestation of exposure to the virus, 4) Management using a combination of supportive care, standard practice intensive care management, and anti-inflammatory agents is associated with recovery, 5) Long-term sequelae of viral exposure is unknown at this time. SUMMARY Emerging evidence suggests pediatric patients are at risk for severe and life-threatening effects of exposure to SARS-CoV2. As the pandemic continues, further research is warranted - particularly as a vaccine is not yet available for use in children.
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Affiliation(s)
- Rahul Damania
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Emory University, Department of Pediatrics, Atlanta, Georgia, USA
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25
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Borrelli M, Corcione A, Castellano F, Fiori Nastro F, Santamaria F. Coronavirus Disease 2019 in Children. Front Pediatr 2021; 9:668484. [PMID: 34123972 PMCID: PMC8193095 DOI: 10.3389/fped.2021.668484] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Since its appearance in Wuhan in mid-December 2019, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related 19 coronavirus disease (COVID-19) has spread dramatically worldwide. It soon became apparent that the incidence of pediatric COVID-19 was much lower than the adult form. Morbidity in children is characterized by a variable clinical presentation and course. Symptoms are similar to those of other acute respiratory viral infections, the upper airways being more affected than the lower airways. Thus far, over 90% of children who tested positive for the virus presented mild or moderate symptoms and signs. Most children were asymptomatic, and only a few cases were severe, unlike in the adult population. Deaths have been rare and occurred mainly in children with underlying morbidity. Factors as reduced angiotensin-converting enzyme receptor expression, increased activation of the interferon-related innate immune response, and trained immunity have been implicated in the relative resistance to COVID-19 in children, however the underlying pathogenesis and mechanism of action remain to be established. While at the pandemic outbreak, mild respiratory manifestations were the most frequently described symptoms in children, subsequent reports suggested that the clinical course of COVID-19 is more complex than initially thought. Thanks to the experience acquired in adults, the diagnosis of pediatric SARS-CoV-2 infection has improved with time. Data on the treatment of children are sparse, however, several antiviral trials are ongoing. The purpose of this narrative review is to summarize current understanding of pediatric SARS-CoV-2 infection and provide more accurate information for healthcare workers and improve the care of patients.
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Affiliation(s)
| | | | | | | | - Francesca Santamaria
- Section of Pediatrics, Pediatric Pulmonology Unit, Department of Translational Medical Sciences, Università di Napoli Federico II, Naples, Italy
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26
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Li Q, Zhou Q, Xun Y, Liu H, Shi Q, Wang Z, Zhao S, Liu X, Liu E, Fu Z, Chen Y, Luo Z. Quality and consistency of clinical practice guidelines for treating children with COVID-19. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:633. [PMID: 33987331 PMCID: PMC8106101 DOI: 10.21037/atm-20-7000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children’s health. Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically. Methods We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed. Results Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22–62%) and 52% (range, 31–89%), respectively. As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19. Conclusions The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.
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Affiliation(s)
- Qinyuan Li
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Zijun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiao Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Enmei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.,GIN Asia, Lanzhou, China.,Chinese GRADE Centre, Lanzhou, China.,Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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27
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Jurado Hernández JL, Álvarez Orozco IF. COVID-19 in Children: Respiratory Involvement and Some Differences With the Adults. Front Pediatr 2021; 9:622240. [PMID: 33855003 PMCID: PMC8039144 DOI: 10.3389/fped.2021.622240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) represents a health problem with multidimensional impacts and heterogeneous respiratory involvement in children, probably due to the interaction between different and complex mechanisms that could explain its variable degrees of severity. Although the majority of reports reveal that children develop less severe cases, the number of patients is increasing with more morbidity. Most serious respiratory manifestations are acute respiratory distress syndrome (ARDS) and pneumonia. By understanding the key aspects that can be used to differentiate between pediatric and adult respiratory compromise by COVID-19, we can improve our knowledge, and thus decrease the negative impact of the disease in the pediatric population. In this mini review, we summarize some of the mechanisms and findings that distinguish between adult and pediatric COVID-19 and respiratory involvement, taking into account some issues related to the physiopathology, diagnosis, clinical and paraclinical presentation, severity, treatment, and control of the disease.
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28
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Belsky JA, Tullius BP, Lamb MG, Sayegh R, Stanek JR, Auletta JJ. COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients. J Infect 2021; 82:329-338. [PMID: 33549624 PMCID: PMC7859698 DOI: 10.1016/j.jinf.2021.01.022] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/03/2020] [Accepted: 01/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical impact of severe coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in immunocompromised patients has not been systematically evaluated. METHODS We reviewed current literature reporting on COVID-19 in cancer (CA), hematopoietic cell (HCT), and solid organ transplant (SOT) patients and compared their clinical data and outcomes to the general population. For adult CA, HCT and SOT patients, an extensive search strategy retrieved all articles published until July 20, 2020 by combining the terms coronavirus, coronavirus infection, COVID-19, and SARS-CoV-2 in PubMed, Cochrane, and Web of Science, and following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. For the pediatric CA cohort, a global COVID-19 registry was used. For the general population cohort, a large meta-analysis was used to compare pooled prevalence estimates, and two large meta-analyses were utilized to serve as pooled comparators for hospitalized COVID-19 patients. FINDINGS Compared to the general population, adult CA and SOT patients with COVID-19 had higher comorbidities, greater levels of inflammatory markers at diagnosis, and higher rates of intensive care and hospital mortality. Pediatric CA patients and HCT patients with COVID-19 tended to have clinical presentations and outcomes similar to the general population. INTERPRETATION To our knowledge, this is the first systematic review evaluating COVID-19 phenotype and outcomes in immunocompromised patients and comparing them to the general population, which shows that hospital outcomes appear to be worse in adult CA and SOT patients, potentially due to their higher co-morbidity burden. FUNDING None.
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Affiliation(s)
- Jennifer A Belsky
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Brian P Tullius
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States.
| | - Margaret G Lamb
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States
| | - Rouba Sayegh
- Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States
| | - Jeffery J Auletta
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, United States; Division of Infectious Diseases, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205 United States; The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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29
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Lee JH, Han HS, Lee JK. The Importance of Early Recognition, Timely Management, and the Role of Healthcare Providers in Multisystem Inflammatory Syndrome in Children. J Korean Med Sci 2021; 36:e17. [PMID: 33429476 PMCID: PMC7801153 DOI: 10.3346/jkms.2021.36.e17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
In April 2020, a pediatric report of an unusual inflammatory illness associated with coronavirus disease 2019 (COVID-19) led to similar cases in Europe and North America, which was referred to as multisystem inflammatory syndrome in children (MIS-C). Herein, we describe the case of a 12-year-old boy who had a history of polymerase chain reaction-confirmed COVID-19 and developed MIS-C approximately three weeks after an initial diagnosis of COVID-19. High fever with abdominal pain mimicking appendicitis was the initial manifestation of MIS-C, which could have been easily missed if the patient's history of COVID-19 was ignored. Intravenous immunoglobulin was administered twice, 24 hours apart, five days after the onset of MIS-C, and the patient fully recovered without any obvious sequelae. Early recognition by disease awareness and prompt management are the keys to saving the lives of children affected by MIS-C.
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Affiliation(s)
- Ji Hyuk Lee
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Heon Seok Han
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Korea
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
- Department of Infection Control and Prevention, Chungbuk National University Hospital, Cheongju, Korea.
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30
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Sood M, Sharma S, Sood I, Sharma K, Kaushik A. Emerging Evidence on Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Infection: a Systematic Review with Meta-analysis. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:38-47. [PMID: 33432304 PMCID: PMC7788276 DOI: 10.1007/s42399-020-00690-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
UNLABELLED With the increased spread of severe acute respiratory syndrome coronavirus 2 infection, more patients with multisystem inflammatory syndrome in children (MIS-C) are being reported worldwide. This systematic review with meta-analysis aims to analyse the clinical features, proposed pathogenesis and current treatment options for effective management of children with this novel entity. Electronic databases (Medline, Google Scholar, WHO, CDC, UK National Health Service, LitCovid, and other databases with unpublished pre-prints) were extensively searched, and all articles on MIS-C published from January 1, 2020, to October 10, 2020, were retrieved. English language studies were included. This systematic review analysed 17 studies with 992 MIS-C patients from low-income and middle-income countries (LMICs) and developed countries (France, the UK, Italy, Spain, Chile and the US CDC data). Fever (95%) was the most common clinical manifestation followed by gastrointestinal (78%), cardiovascular (75.5%), and respiratory system (55.3%) involvement. Laboratory or epidemiologic evidence of inflammation and SARS-CoV-2 infection was present. Though the exact pathogenesis remains elusive, virus-induced post-infective immune dysregulation appears to play a predominant role. Features resembling Kawasaki disease, toxic shock syndrome or macrophage activation syndrome were present; 49% had shock; 32% had myocarditis; 18% had coronary vessel abnormalities and 9% had congestive cardiac failure. Sixty-three percent of the patients were admitted in paediatric intensive care unit (PICU); 63% received intravenous immunoglobulin, 58% received corticosteroids and 19% received alternate agents like tocilizumab; there were 22 (2.2%) deaths. Only 9/144 children in LMICs received tocilizumab that was significantly less than children in developed countries (p < 0.0001). This systematic review delineates and summarises recently published data on MIS-C from LMICs and developed countries. Although most needed PICU admission and received treatment with IVIG and steroids, most of the patients survived. Significantly fewer patients in developing countries received tocilizumab therapy than those in developed countries. It is crucial for clinician to recognise MIS-C, to differentiate it from other defined inflammatory conditions and initiate early treatment. Further studies are needed for long-term prognosis, especially relating to cardiac complications of MIS-C. SUPPLEMENTARY INFORMATION The online version of this article (10.1007/s42399-020-00690-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh 171001 India
| | - Seema Sharma
- Department of Pediatrics, Dr RPG Medical College, Kangra, Himachal Pradesh 176002 India
| | - Ishaan Sood
- Indira Gandhi Medical College, Shimla, Himachal Pradesh 171001 India
| | - Kavya Sharma
- MM Medical College, Solan, Himachal Pradesh 173229 India
| | - Ashlesha Kaushik
- Department of Pediatrics, University of Iowa Carver College of Medicine, 2720 Stone Park Blvd, Sioux City, IA 51104 USA
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31
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Shirley DA, Moonah S. COVID-19 and Corticosteroids: Unfamiliar but Potentially Fatal Infections That Can Arise following Short-Course Steroid Treatment. Am J Trop Med Hyg 2021; 104:790-793. [PMID: 33410395 PMCID: PMC7941796 DOI: 10.4269/ajtmh.20-1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Corticosteroid use is increasing worldwide as recent studies confer survival benefit of corticosteroids in the management of patients with severe COVID-19. Strongyloides and amebic infections are neglected diseases that can progress to catastrophic complications in patients exposed to corticosteroids, even with short treatment courses. To prevent lethal outcomes, clinicians should be aware of the threat these two parasitic infections pose to at-risk patients receiving corticosteroids, especially in the era of COVID-19.
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Affiliation(s)
- Debbie-Ann Shirley
- Division of Infectious Diseases and International Health, University of Virginia COVID-19 Clinic, University of Virginia Health System, Charlottesville, Virginia
| | - Shannon Moonah
- Division of Infectious Diseases and International Health, University of Virginia COVID-19 Clinic, University of Virginia Health System, Charlottesville, Virginia
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