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Sun YK, Wang C, Lin PQ, Hu L, Ye J, Gao ZG, Lin R, Li HM, Shu Q, Huang LS, Tan LH. Severe pediatric COVID-19: a review from the clinical and immunopathophysiological perspectives. World J Pediatr 2024; 20:307-324. [PMID: 38321331 PMCID: PMC11052880 DOI: 10.1007/s12519-023-00790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) tends to have mild presentations in children. However, severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times, meriting further attention from clinicians. Meanwhile, the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood. DATA SOURCES A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included "COVID-19 in children", "severe pediatric COVID-19", and "critical illness in children with COVID-19". RESULTS Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines. CONCLUSIONS Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
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Affiliation(s)
- Yi-Kan Sun
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310030, China
| | - Can Wang
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Pei-Quan Lin
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Lei Hu
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Jing Ye
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Zhi-Gang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Ru Lin
- Department of Cardiopulmonary and Extracorporeal Life Support, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Hao-Min Li
- Clinical Data Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Qiang Shu
- Department of Cardiac Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
- National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Li-Su Huang
- National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
| | - Lin-Hua Tan
- Surgical Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
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Díaz F, Cruces P. Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View. J Pediatr Intensive Care 2024; 13:1-6. [PMID: 38571985 PMCID: PMC10987222 DOI: 10.1055/s-0041-1732345] [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: 05/08/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
Advanced airway management of critically ill children is crucial for novel coronavirus disease 2019 (COVID-19) management in the pediatric intensive care unit, whether due to shock and hemodynamic collapse or acute respiratory failure. In this article, intubation is challenging due to the particularities of children's physiology and the underlying disease's pathophysiology, especially when an airborne pathogen, like COVID-19, is present. Unfortunately, published recommendations and guidelines for COVID-19 in pediatrics do not address in-depth endotracheal intubation in acutely ill children. We discussed the caveats and pitfalls of intubation in critically ill children.
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Affiliation(s)
- Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
| | - Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
- Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
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Fernández-Sarmiento J, Acevedo L, Niño-Serna LF, Boza R, García-Silva J, Yock-Corrales A, Yamazaki-Nakashimada MA, Faugier-Fuentes E, Del Águila O, Camacho-Moreno G, Estripeaut D, Gutiérrez IF, Luciani K, Espada G, Álvarez-Olmos MI, Pérez-Camacho P, Duarte-Passos S, Cervi MC, Cantillano EM, Llamas-Guillén BA, Saltigeral-Simental P, Criales J, Chacon-Cruz E, García-Domínguez M, Aguilar KLB, Jarovsky D, Ivankovich-Escoto G, Tremoulet AH, Ulloa-Gutierrez R. Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network. J Intensive Care Med 2024:8850666241233189. [PMID: 38414438 DOI: 10.1177/08850666241233189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Lorena Acevedo
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | | | - Raquel Boza
- Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Adriana Yock-Corrales
- Servicio de Emergencias, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - German Camacho-Moreno
- Unidad de Infectología Pediátrica, Fundación Hospital Pediátrico La Misericordia (HOMI), Bogotá, Colombia
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Iván F Gutiérrez
- Servicio de Infectología, Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Ciudad de Panamá, Panamá
| | - Graciela Espada
- Servicio de Reumatología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Paola Pérez-Camacho
- Servicio de Infectología, Fundación Valle del Lili & Departamento de Pediatría, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Saulo Duarte-Passos
- Hospital Universitario de Faculdade de Medicina de Jundiai, Sao Paolo, Brazil
| | - Maria C Cervi
- Serviço de Infectología, Faculdade de Medicina de Ribeirāo Preto, Universidade de Sāo Paulo, Sao Paulo, Brazil
| | - Edwin M Cantillano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro de Sula, Honduras
| | | | - Patricia Saltigeral-Simental
- Servicio de Infectología, Star Médica Hospital Infantil Privado e Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Enrique Chacon-Cruz
- Servicio de Infectología. Hospital General de Tijuana, Tijuana, México
- Think Vaccines LLC, Houston, Texas, USA
| | - Miguel García-Domínguez
- Servicio de Alergología e Inmunología, Hospital Pediátrico de Sinaloa "Dr Rigoberto Aguilar Pico," Sinaloa, México
| | - Karla L Borjas Aguilar
- Servicio de Inmunología, Hospital María, Especialidades Pediátricas e Instituto Hondureño de Seguridad Social, Hospital de Especialidades, Tegucigalpa, Honduras
| | - Daniel Jarovsky
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Gabriela Ivankovich-Escoto
- Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego (UCSD) & Rady Children's Hospital, San Diego, California, USA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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Schulz A, Huynh N, Heger M, Bakir M. Adverse effects of remdesivir for the treatment of acute COVID-19 in the pediatric population: a retrospective observational study. Mol Cell Pediatr 2024; 11:2. [PMID: 38381231 PMCID: PMC10881938 DOI: 10.1186/s40348-024-00175-9] [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: 11/22/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Although the severity of coronavirus disease 2019 (COVID-19) tends to be lower in children, it can still lead to severe illness, particularly among those with chronic medical conditions. While remdesivir (RDV) is one of the few approved antiviral treatments for COVID-19 in children in many countries, the available data on the safety of RDV in this population is limited. METHODS To address this knowledge gap, a multicenter study involving 65 patients retrospectively analyzed the clinical data from individuals aged <18 who were hospitalized due to severe COVID-19 (defined as SpO2 < 94% or requiring supplemental oxygen) and received at least one dose of RDV. Additionally, the study encompassed 22 patients with mild-moderate COVID-19 who were considered at high risk of developing severe disease. RESULTS Nineteen children (29%) experienced mild-to-moderate adverse events (AEs) attributed to RDV, including transaminitis in 20% of children, bradycardia in 8%, and hypotension in 5%. AEs did not require discontinuation of RDV, except in one patient who developed premature ventricular contractions. The rate of AEs did not differ between patients with severe COVID-19 and those with mild-moderate COVID-19 but at high risk for severe disease. All but one patient were discharged within 23 days of admission, and no fatalities were recorded. Among high-risk patients with mild-moderate disease, only 2 (9%) progressed to the point of needing supplemental oxygen. CONCLUSIONS Our data suggests that RDV is safe in children, with no reported serious AEs. However, the absence of a control group limits the extent to which conclusions can be drawn. RDV may contribute to clinical improvement, particularly in high-risk patients.
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Affiliation(s)
- Abigail Schulz
- University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, North Building #6606, Peoria, IL, 61637, USA
| | - Natalie Huynh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, North Building #6606, Peoria, IL, 61637, USA
| | - Margaret Heger
- Department of Pharmacy, OSF HealthCare Children's Hospital of Illinois, Peoria, IL, USA
| | - Mustafa Bakir
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, North Building #6606, Peoria, IL, 61637, USA.
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Schott W, Tao S, Shea L. Prevalence of high-risk conditions for severe COVID-19 among Medicaid-enrolled children with autism and mental health diagnoses in the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2145-2157. [PMID: 36799305 PMCID: PMC9941459 DOI: 10.1177/13623613231155265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
LAY ABSTRACT Children are at risk of varying severity of illness and even death from COVID-19. We aim to determine whether autistic children or children with mental health conditions have more underlying health conditions that put people at risk of severe illness from COVID-19. We use data from a national sample of Medicaid-enrolled children for the years 2008-2016. These data include children across the 50 states and the District of Columbia. We compare the prevalence of underlying conditions among autistic children and children with mental health condition to that of other children in Medicaid. This study included 888,487 autistic children, 423,397 with any mental health condition (but not autism), and 932,625 children without any of these diagnoses. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had over twice the odds of having any underlying conditions, when accounting for age, race, sex, and other characteristics. Children with mental health conditions had 70% higher odds of having these underlying conditions. Mitigation measures in schools and other areas could minimize risk of short- and long-term impacts from COVID for autistic and all children.
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Tonge JJ, Stevens O, Dawson J, Hawley D, Kerrison C, Krone N, Maltby SL, McMahon AM, Shackley F, Talekar R, Gonzalez-Martinez C, Lawrence N. Assessing the Response of Biomarkers to Anti-Inflammatory Medications in PIMS-TS by Longitudinal Multilevel Modeling: Real-World Data from a UK Tertiary Center. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:94-103. [PMID: 37433192 DOI: 10.1089/ped.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Background: Pediatric inflammatory multisystem syndrome temporarily associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PIMS-TS) is an acute complication of previous SARS-CoV-2 exposure. The relationship between inflammatory markers and anti-inflammatory medication in PIMS-TS is unknown. We retrospectively investigated the relationship between demographics, biomarkers, treatment, and length of stay (LOS) in this novel disease. Methods: We reviewed the case notes and blood tests of all patients who met the Royal College of Paediatrics and Child Health diagnostic criteria for PIMS-TS at a large tertiary center in the United Kingdom. Biomarker trajectories were modeled using log linear mixed effects, and factors affecting LOS in hospital were evaluated using multiple regression. Results: Between March 2020 and May 2022, a total of 56 patients attended Sheffield Children's Hospital with PIMS-TS, 70% male. Mean age was 7.4 ± 3.7 years and mean LOS 8.7 ± 4.5 days with 50% requiring intensive care and 20% requiring inotropes. Older males had shorter LOS than younger males (P = 0.04), not seen in females. Treatment included intravenous glucocorticoids in 93%, intravenous immunoglobulins (IVIG) in 77%, Anakinra in 11%, and infliximab in 1.8%. Biomarkers correlated poorly with trajectories that peaked at different times. C-reactive protein peaked first after median 1.3 days postadmission; while LFT's and neutrophils peaked after 3 days. Age had a large effect on some biomarkers, with older children having larger troponin and ferritin, and lower lymphocytes and platelets. Cumulative dose of glucocorticoids and IVIG had a statistically significant effect on some biomarkers, but effect size was small. Conclusions: The heterogenous nature of PIMS-TS highlights the importance of a multidisciplinary approach. Worse inflammatory markers in older children within our cohort may be an indication of a different disease process occurring at different ages. Future work to investigate the association between age and troponin and ferritin in hyperinflammatory states is warranted.
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Affiliation(s)
- Joseph J Tonge
- Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
| | - Olivia Stevens
- Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
| | - Jeremy Dawson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Management School, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Hawley
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Caroline Kerrison
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Nils Krone
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Sarah L Maltby
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Anne-Marie McMahon
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Fiona Shackley
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Rupa Talekar
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Neil Lawrence
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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Totapally BR, Nadiger M, Hassor S, Laufer M, Etinger V, Ramos O, Biehler J, Meyer K, Melnick S. Identification of Multisystem Inflammatory Syndrome in Children Classes and Development of Hyperinflammation Score in Pediatric COVID-19. J Pediatr Intensive Care 2023; 12:137-147. [PMID: 37082465 PMCID: PMC10113008 DOI: 10.1055/s-0041-1730932] [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: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 01/08/2023] Open
Abstract
The aim of this study is to describe characteristics and hospital course of children admitted with COVID-19 to a tertiary care pediatric center in Southeastern United States, and to present the frequency of three classes of multisystem inflammatory syndrome in children (MIS-C) and develop pediatric COVID-19 associated hyperinflammation score (PcHIS). A retrospective cohort study of 68 children was performed. Critical illness was defined as any child requiring respiratory or cardiovascular support or renal replacement therapy. PcHIS was developed by using six variables: fever, hematological dysfunction, coagulopathy, hepatic injury, macrophage activation, and cytokinemia. Centers for Disease Control and Prevention criteria were used to identify MIS-C, and three classes of MIS-C were identified based on the findings of recently published latent class analysis (Class 1: MIS-C without Kawasaki like disease, Class 2: MIS-C with respiratory disease, and Class 3: MIS-C with Kawasaki like disease). The median age was 6.4 years. Fever, respiratory, and gastrointestinal were common presenting symptoms. MIS-C was present in 32 (47%), critical COVID-19 illness in 11 (16%), and 17 (25%) were admitted to the PICU. Children with critical illness were adolescents with elevated body mass index and premorbid conditions. PcHIS score of 3 had a sensitivity of 100% and a specificity of 77% for predicting critical COVID-19 illness. Among MIS-C patients, 15 (47%) were in Class 1, 8 (25%) were in Class 2, and 9 (28%) were in Class 3. We conclude that most children with COVID-19 have mild-to-moderate illness. Critical COVID-19 is mainly seen in obese adolescents with premorbid conditions. Three Classes of MIS-C are identifiable based on clinical features. Validation and clinical implication of inflammation score in pediatric COVID-19 need further investigation.
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Affiliation(s)
- Balagangadhar R. Totapally
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Meghana Nadiger
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Sophia Hassor
- Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Marcelo Laufer
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Infectious Diseases, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Veronica Etinger
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Otto Ramos
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Division of Infectious Diseases, Nicklaus Children's Hospital, Miami, Florida, United States
| | - Jefry Biehler
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Keith Meyer
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida, United States
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Steven Melnick
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
- Department of Pathology, Nicklaus Children's Hospital, Miami, Florida, United States
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Ng Q, Loke YH, Smith KL, DeBiasi RL, Berul CI, Sharron MP, Wessel D, Bost JE, Lowndes RW, Ansusinha E, Mehrtens K, Schultz J, Harahsheh AS. Cardiac evaluation of hospitalized children with 2019 coronavirus (COVID-19) infection at a single large quaternary center. Heliyon 2023; 9:e17395. [PMID: 37366529 PMCID: PMC10277255 DOI: 10.1016/j.heliyon.2023.e17395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background Cardiac complications of serious SARS-CoV-2 infections, especially Multisystem Inflammatory Syndrome of Children (MIS-C) are well described, however current studies have not considered pediatric patients hospitalized with no cardiac concerns. We established a protocol for cardiac evaluation of all admitted COVID-19 patients three weeks post-discharge, irrespective of cardiac concerns. We assessed cardiovascular outcomes and hypothesized that patients with absent cardiac concerns are at lower risk for cardiac abnormalities. Methods This was a retrospective study of 160 patients admitted for COVID-19 (excluding MIS-C) between March 2020 and September 2021 with subsequent echocardiogram(s) performed at our center. Patients were divided into 4 subgroups: Group 1 included patients with absent cardiac concerns, admitted to acute care (1a) and intensive care unit (ICU) (1 b). Group 2 included patients with cardiac concerns, admitted to acute care (2a) and ICU (2 b). Groups were compared based on clinical endpoints and echocardiographic measurements, including tissue Doppler imaging (TDI) assessment of diastolic function (z-score of septal Mitral E/TDI E' and lateral E/TDI E'). Chi-squared, Fisher's exact, and Kruskal-Wallis tests were used. Results Traditional cardiac abnormalities varied significantly between the groups; with Group 2 b having the most (n = 8, 21%), but still found in Group 1a (n = 2, 3%) and Group 1 b (n = 1, 5%). No patients in Group 1 demonstrated abnormal systolic function, compared to Group 2a (n = 1, 3%) and Group 2 b (n = 3, 9%, p = 0.07). When including TDI assessment of diastolic function, the total incidence of abnormalities found on echocardiogram was increased in all groups. Conclusion Cardiac abnormalities were found in pediatric patients admitted with COVID-19, even those without apparent cardiovascular concerns. The risk was greatest in ICU-admitted patients with cardiac concerns. The clinical significance of diastolic function assessment in these patients remains unknown. Further studies are needed to assess long-term cardiovascular sequelae of children with COVID-19, irrespective of cardiac concerns.
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Affiliation(s)
- Qimin Ng
- Pediatric Residency Program, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Karen L Smith
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Hospital Medicine, Children's National Hospital, Washington, DC, USA
| | - Roberta L DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Charles I Berul
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Matthew P Sharron
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - James E Bost
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Division of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Robert W Lowndes
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Emily Ansusinha
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
| | - Kristine Mehrtens
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - John Schultz
- Division of Ambulatory Services, Children's National Hospital, Washington, DC, USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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9
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C R V, Sharma R, Jayashree M, Nallasamy K, Bansal A, Angurana SK, L Mathew J, Sankhyan N, Dutta S, Verma S, Kumar R, Devnanai M, Vaidya PC, Samujh R, Singh MP, Goyal K, Lakshmi PVM, Saxena AK. Epidemiology, Clinical Profile, Intensive Care Needs and Outcome in Children with SARS-CoV-2 Infection Admitted to a Tertiary Hospital During the First and Second Waves of the COVID-19 Pandemic in India. Indian J Pediatr 2023; 90:131-138. [PMID: 35921029 PMCID: PMC9362352 DOI: 10.1007/s12098-022-04283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the epidemiological, clinical profile, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the first and second waves of the pandemic. METHODS This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the first (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). RESULTS Of 217 children, 104 (48%) and 113 (52%) were admitted during the first and second waves respectively. One hundred fifty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-flow oxygen (n = 5, 2%), noninvasive ventilation [CPAP (n = 34, 16%) and BiPAP (n = 8, 5%)] and invasive ventilation (n = 45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p = 0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the first wave [8 (6-10) vs. 5.5 (3-8); p = 0.0001]. CONCLUSIONS Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the first and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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Affiliation(s)
- Vishwa C R
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raman Sharma
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Joseph L Mathew
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Verma
- Division of Pediatric Infectious Disease, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mahesh Devnanai
- Division of Hospital Administration, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj C Vaidya
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Corvol H, Prevost B, Aubertin G, Thouvenin G, Taytard J, Nathan N. COVID-19 and pediatric pulmonology: Feedback from an expert center after the first year of the pandemic. Pediatr Pulmonol 2023; 58:392-397. [PMID: 36353967 PMCID: PMC9878247 DOI: 10.1002/ppul.26235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has evolved with different waves corresponding to subsequent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations. While the most severe cases have been observed in the elderly and in individuals with underlying comorbidities, severe pediatric and young adult cases have been observed, as well as post-infectious inflammatory syndromes and persistent symptoms leading to long-COVID. This manuscript describes the experience of a pediatric respiratory unit during the first year of the pandemic and reviews the corresponding literature with a special emphasis on children and young people with underlying conditions, such as immunosuppression, sickle cell disease, and cystic fibrosis.
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Affiliation(s)
- Harriet Corvol
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Blandine Prevost
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Guillaume Aubertin
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Guillaume Thouvenin
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Jessica Taytard
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Inserm UMRS_S1158, Paris, France
| | - Nadia Nathan
- Service de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare et Centre de Ressources et de Compétences pour la Mucoviscidose, Sorbonne Université et APHP, Hôpital Armand Trousseau, Paris, France.,Inserm UMR_S933, Paris, France
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11
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Buonsenso D, Roland D, Yock-Corrales A, González-Dambrauskas S, Brodin P, Santiago-Garcia B, Soriano-Arandes A, Koenraads M, De Luca D, Whittaker E. The challenges of doing paediatric research during the first year of the covid-19 pandemic. BMJ 2022; 379:o2750. [PMID: 36379549 DOI: 10.1136/bmj.o2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Damian Roland
- Sapphire Group, Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Adriana Yock-Corrales
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," San José, Costa Rica
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Petter Brodin
- Pediatric Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, A Béclère Medical Centre, Paris Saclay University Hospitals, Paris, France
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, UK
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12
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Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, Francoeur C, Gurbanov A, Mazzillo-Vega L, Shein SL, Yock-Corrales A, Karsies T. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100272. [PMID: 35599855 PMCID: PMC9111167 DOI: 10.1016/j.lana.2022.100272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. METHODS Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. FINDINGS 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. INTERPRETATION We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. FUNDING None.
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Affiliation(s)
- Sebastian Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy
| | - Edwin Mauricio Cantillano
- UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Samantha Dallefeld
- Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Jesus Dominguez-Rojas
- Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú
| | - Conall Francoeur
- Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adriana Yock-Corrales
- Emergency Department. Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS. San José, Costa Rica
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA
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13
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McDaniel CG, Commander SJ, DeLaura I, Cantrell S, Leraas HJ, Moore CB, Reed CR, Pahl KS, Tracy ET. Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients. J Pediatr Hematol Oncol 2022; 44:323-335. [PMID: 34862349 DOI: 10.1097/mph.0000000000002321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
Given the limited information on the coagulation abnormalities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients, we designed a systematic review to evaluate this topic. A comprehensive literature search was conducted for "SARS-CoV-2," "coagulopathy," and "pediatrics." Two authors independently screened the articles that the search returned for bleeding, thrombosis, anticoagulant and/or antiplatelet usage, and abnormal laboratory markers in pediatric patients with SARS-CoV-2, and the authors then extracted the relevant data. One hundred twenty-six publications were included. Thirty-four (27%) studies reported thrombotic complications in 504 patients. Thirty-one (25%) studies reported bleeding complications in 410 patients. Ninety-eight (78%) studies reported abnormal laboratory values in 6580 patients. Finally, 56 (44%) studies reported anticoagulant and/or antiplatelet usage in 3124 patients. The variety of laboratory abnormalities and coagulation complications associated with SARS-CoV-2 presented in this review highlights the complexity and variability of the disease presentation in infants and children.
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Affiliation(s)
| | | | | | - Sarah Cantrell
- Duke University School of Medicine
- Duke University Medical Center Library and Archives, Durham, NC
| | | | | | | | - Kristy S Pahl
- Division of Pediatric Hematology-Oncology
- Department of Pediatrics
| | - Elisabeth T Tracy
- Department of Surgery
- Division of Pediatric Surgery, Duke University Medical Center
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14
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Statsenko Y, Habuza T, Talako T, Pazniak M, Likhorad E, Pazniak A, Beliakouski P, Gelovani JG, Gorkom KNV, Almansoori TM, Al Zahmi F, Qandil DS, Zaki N, Elyassami S, Ponomareva A, Loney T, Naidoo N, Mannaerts GHH, Al Koteesh J, Ljubisavljevic MR, Das KM. Deep Learning-Based Automatic Assessment of Lung Impairment in COVID-19 Pneumonia: Predicting Markers of Hypoxia With Computer Vision. Front Med (Lausanne) 2022; 9:882190. [PMID: 35957860 PMCID: PMC9360571 DOI: 10.3389/fmed.2022.882190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/14/2022] [Indexed: 01/19/2023] Open
Abstract
Background Hypoxia is a potentially life-threatening condition that can be seen in pneumonia patients. Objective We aimed to develop and test an automatic assessment of lung impairment in COVID-19 associated pneumonia with machine learning regression models that predict markers of respiratory and cardiovascular functioning from radiograms and lung CT. Materials and Methods We enrolled a total of 605 COVID-19 cases admitted to Al Ain Hospital from 24 February to 1 July 2020 into the study. The inclusion criteria were as follows: age ≥ 18 years; inpatient admission; PCR positive for SARS-CoV-2; lung CT available at PACS. We designed a CNN-based regression model to predict systemic oxygenation markers from lung CT and 2D diagnostic images of the chest. The 2D images generated by averaging CT scans were analogous to the frontal and lateral view radiograms. The functional (heart and breath rate, blood pressure) and biochemical findings (SpO2, HCO3-, K+, Na+, anion gap, C-reactive protein) served as ground truth. Results Radiologic findings in the lungs of COVID-19 patients provide reliable assessments of functional status with clinical utility. If fed to ML models, the sagittal view radiograms reflect dyspnea more accurately than the coronal view radiograms due to the smaller size and the lower model complexity. Mean absolute error of the models trained on single-projection radiograms was approximately 11÷12% and it dropped by 0.5÷1% if both projections were used (11.97 ± 9.23 vs. 11.43 ± 7.51%; p = 0.70). Thus, the ML regression models based on 2D images acquired in multiple planes had slightly better performance. The data blending approach was as efficient as the voting regression technique: 10.90 ± 6.72 vs. 11.96 ± 8.30%, p = 0.94. The models trained on 3D images were more accurate than those on 2D: 8.27 ± 4.13 and 11.75 ± 8.26%, p = 0.14 before lung extraction; 10.66 ± 5.83 and 7.94 ± 4.13%, p = 0.18 after the extraction. The lung extraction boosts 3D model performance unsubstantially (from 8.27 ± 4.13 to 7.94 ± 4.13%; p = 0.82). However, none of the differences between 3D and 2D were statistically significant. Conclusion The constructed ML algorithms can serve as models of structure-function association and pathophysiologic changes in COVID-19. The algorithms can improve risk evaluation and disease management especially after oxygen therapy that changes functional findings. Thus, the structural assessment of acute lung injury speaks of disease severity.
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Affiliation(s)
- Yauhen Statsenko
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Abu Dhabi Precision Medicine Virtual Research Institute (AD PM VRI), United Arab Emirates University, Al Ain, United Arab Emirates
- *Correspondence: Yauhen Statsenko
| | - Tetiana Habuza
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
- Big Data Analytics Center, United Arab Emirates University, Al Ain, United Arab Emirates
- Tetiana Habuza
| | - Tatsiana Talako
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Elena Likhorad
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Eye Microsurgery Center “Voka”, Minsk, Belarus
- Elena Likhorad
| | | | | | - Juri G. Gelovani
- Biomedical Engineering Department, College of Engineering, Wayne State University, Detroit, MI, United States
- Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Klaus Neidl-Van Gorkom
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatmah Al Zahmi
- Department of Neurology, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- Department of Clinical Science, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Dana Sharif Qandil
- College of Medical Sciences, Ras Al Khaimah Medical Health and Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Nazar Zaki
- Abu Dhabi Precision Medicine Virtual Research Institute (AD PM VRI), United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sanaa Elyassami
- Department of Computer Science, Abu Dhabi Polytechnic, Abu Dhabi, United Arab Emirates
| | - Anna Ponomareva
- Scientific-Research Institute of Medicine and Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Tom Loney
- Department of Public Health and Epidemiology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nerissa Naidoo
- Department of Anatomy, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Guido Hein Huib Mannaerts
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Surgery, Tawam Hospital, Abu Dhabi, United Arab Emirates
| | - Jamal Al Koteesh
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Radiology, Tawam Hospital, Abu Dhabi, United Arab Emirates
- Jamal Al Koteesh
| | - Milos R. Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Karuna M. Das
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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15
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Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. More than 5 million children have been infected in the United States. Risk factors for more severe disease progression include obesity, pulmonary disease, gastrointestinal disorders, and neurologic comorbidities. Children with COVID-19 are admitted to the pediatric intensive care unit because of severe acute COVID-19 illness or COVID-19-associated multisystem inflammatory syndrome in children. The delta surge of 2021 was responsible for an increased disease burden in children and points to the key role of vaccinating children against this sometimes-deadly disease.
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Affiliation(s)
- Meena Kalyanaraman
- Pediatric Critical Care Medicine, Children's Hospital of New Jersey at Newark Beth Israel Medical Center, C-5, 201 Lyons Avenue, Newark, NJ 07112, USA.
| | - Michael R. Anderson
- Children’s National Hospital, George Washington University School of Medicine and Health Sciences
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16
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Klučka J, Klabusayová E, Kratochvíl M, Musilová T, Vafek V, Skříšovská T, Kosinová M, Havránková P, Štourač P. Critically Ill Pediatric Patient and SARS-CoV-2 Infection. CHILDREN 2022; 9:children9040538. [PMID: 35455582 PMCID: PMC9024430 DOI: 10.3390/children9040538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 01/08/2023]
Abstract
In December 2019 SARS-CoV-2 initiated a worldwide COVID-19 pandemic, which is still ongoing in 2022. Although adult elderly patients with chronic preexisting diseases had been identified as the most vulnerable group, COVID-19 has also had a significant impact on pediatric intensive care. Early in 2020, a new disease presentation, multisystemic inflammatory syndrome, was described in children. Despite the vaccination that is available for all age categories, due to its selection process, new viral mutations and highly variable vaccination rate, COVID-19 remains a significant clinical challenge in adult and pediatric intensive care in 2022.
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Affiliation(s)
- Jozef Klučka
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Eva Klabusayová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Kratochvíl
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tereza Musilová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Václav Vafek
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tamara Skříšovská
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-53223-469
| | - Pavla Havránková
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Anaesthesiology and Intensive Care Medicine, The Donaustadt Clinic, Lango Bardenstraße 122, 1220 Vienna, Austria
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (E.K.); (M.K.); (T.M.); (V.V.); (T.S.); (P.H.); (P.Š.)
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
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17
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Síndrome inflamatorio multisistémico en niños asociado a COVID-19. Revisión narrativa de la literatura a propósito de un caso. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC7680037 DOI: 10.1016/j.acci.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Durante la pandemia actual, declarada por la Organización Mundial de la Salud en marzo de 2020, la literatura ha enfatizado que la enfermedad por SARS-CoV-2 en niños tiene un curso leve a moderado. Con el avance de la epidemia en las grandes ciudades del mundo se empezaron a reportar niños que presentaban características clínicas de un síndrome hiperinflamatorio, algunos con choque y compromiso multisistémico, con características similares a la enfermedad de Kawasaki y síndrome de choque tóxico, en pacientes previamente sanos, o con comorbilidades que cursan con infección reciente o actual por COVID-19 o con nexo epidemiológico claro para COVID-19, que fue denominada por el CDC como síndrome inflamatorio multisistémico en niños asociado a COVID-19 (MIS-C). En Colombia se han empezado a presentar este tipo de casos, pero hasta el momento no se tiene reporte clínico de los pacientes pediátricos con este diagnóstico. Se describe un caso de MIS-C con signos de choque distributivo y falla orgánica multisistémica. Se describen los hallazgos particulares en esta paciente y el tratamiento brindado, en vista de la ausencia de consensos regionales para el tratamiento de esta enfermedad. El caso descrito presenta evidencia de compromiso neurológico grave y sangrado de sistema nervioso central, poco descrito en la literatura pediátrica como una complicación potencialmente fatal. Se realizó una revisión narrativa de la literatura publicada hasta el momento.
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18
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Kontou M, Kakleas K, Kimioni V, Georgiadi D, Spoulou V, Michos A. Rhabdomyolysis and coronavirus disease‐2019 in children: A case report and review of the literature. Pediatr Investig 2022; 6:135-139. [PMID: 35774521 PMCID: PMC9218973 DOI: 10.1002/ped4.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Coronavirus disease‐2019 (COVID‐19) presents with a variety of symptoms, but rhabdomyolysis has rarely been reported in children. Case presentation We report a 10‐year‐old girl who presented with fever, myalgia, and limping. The patient was tested positive for severe acute respiratory syndrome coronavirus‐2. On admission, creatine kinase (CK) level was 13 147 units per liter and the patient was diagnosed with rhabdomyolysis. She was treated with intravenous fluids, which resulted in CK levels decrease. There are currently seven case reports of children with rhabdomyolysis associated with acute COVID‐19 infection and two reports with the multisystemic inflammatory syndrome. Conclusion Children presenting with muscle pain and weakness in the acute phase or following COVID‐19 infection, should alert physicians of the possibility of rhabdomyolysis.
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Affiliation(s)
- Maria Kontou
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Konstantinos Kakleas
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Vaso Kimioni
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Dimitra Georgiadi
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Vasiliki Spoulou
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Athanasios Michos
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School “Aghia Sophia” Children's Hospital, National and Kapodistrian University of Athens Athens Greece
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19
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Tosif S, Ibrahim LF, Hughes R, R Cheng D, Wurzel D, Overmars I, Steer AC, Bryant PA, Duke T, Lewena S, Babl FE, McNab S, Crawford N. Characteristics and outcomes of SARS-CoV-2 infection in Victorian children at a tertiary paediatric hospital. J Paediatr Child Health 2022; 58:618-623. [PMID: 34693586 PMCID: PMC8662161 DOI: 10.1111/jpc.15786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/10/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022]
Abstract
AIM Victoria experienced two 'waves' of COVID-19 between March and September 2020 and more cases than any other jurisdiction in Australia. Although world-wide reports of COVID-19 reflect that children are less likely to experience severe disease compared with adults, hospitalisations and deaths have been reported. We report testing and outcomes of children with SARS-CoV-2 infection presenting to a tertiary paediatric hospital in Melbourne. METHODS We conducted a prospective cohort study at The Royal Children's Hospital (RCH), including all children and adolescents (aged 0-18 years) who presented and were tested for SARS-CoV-2 over a 6-month period, between 21 March 2020, up to the 21 September 2020. Detailed epidemiological and clinical data were recorded. RESULTS A total of 19 708 tests for SARS-CoV-2 were performed in 14 419 patients. One hundred and eighty patients tested positive for SARS-CoV-2 (1.2%). 110 (61%) were symptomatic, 60 (33%) were asymptomatic and 10 (6%) were pre-symptomatic. Close contacts of a positive case were associated with a higher risk of a testing positive for SARS-CoV-2 (120/2027 (6%) vs. 60/14589 (0.4%), RD 5.5 (95% CI 4.5 to 6.5), P < 0.001). Eighteen (10%) SARS-CoV-2-positive patients were admitted to hospital with one patient requiring intensive care. All patients recovered fully with no deaths. CONCLUSION In Victorian children presenting to a tertiary hospital, SARS-CoV-2 infection caused predominantly mild or asymptomatic infection, with most children not requiring hospitalisation.
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Affiliation(s)
- Shidan Tosif
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Laila F Ibrahim
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Rebecca Hughes
- Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Daryl R Cheng
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia,Department of Respiratory MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Isabella Overmars
- Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Andrew C Steer
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Penelope A Bryant
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Trevor Duke
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Intensive Care UnitThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Stuart Lewena
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Franz E Babl
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Sarah McNab
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel Crawford
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
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20
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Herrera-Esposito D, de Los Campos G. Age-specific rate of severe and critical SARS-CoV-2 infections estimated with multi-country seroprevalence studies. BMC Infect Dis 2022; 22:311. [PMID: 35351016 DOI: 10.1101/2021.07.29.21261282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/11/2022] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Knowing the age-specific rates at which individuals infected with SARS-CoV-2 develop severe and critical disease is essential for designing public policy, for infectious disease modeling, and for individual risk evaluation. METHODS In this study, we present the first estimates of these rates using multi-country serology studies, and public data on hospital admissions and mortality from early to mid-2020. We combine these under a Bayesian framework that accounts for the high heterogeneity between data sources and their respective uncertainties. We also validate our results using an indirect method based on infection fatality rates and hospital mortality data. RESULTS Our results show that the risk of severe and critical disease increases exponentially with age, but much less steeply than the risk of fatal illness. We also show that our results are consistent across several robustness checks. CONCLUSION A complete evaluation of the risks of SARS-CoV-2 for health must take non-fatal disease outcomes into account, particularly in young populations where they can be 2 orders of magnitude more frequent than deaths.
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Affiliation(s)
- Daniel Herrera-Esposito
- Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay.
- Centro Interdisciplinario de Ciencia de Datos y Aprendizaje Automático, Universidad de la República, Montevideo, Uruguay.
| | - Gustavo de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
- Institute for Quantitative Health Science and Engineering, East Lansing, MI, USA
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21
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Herrera-Esposito D, de Los Campos G. Age-specific rate of severe and critical SARS-CoV-2 infections estimated with multi-country seroprevalence studies. BMC Infect Dis 2022; 22:311. [PMID: 35351016 PMCID: PMC8962942 DOI: 10.1186/s12879-022-07262-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background Knowing the age-specific rates at which individuals infected with SARS-CoV-2 develop severe and critical disease is essential for designing public policy, for infectious disease modeling, and for individual risk evaluation. Methods In this study, we present the first estimates of these rates using multi-country serology studies, and public data on hospital admissions and mortality from early to mid-2020. We combine these under a Bayesian framework that accounts for the high heterogeneity between data sources and their respective uncertainties. We also validate our results using an indirect method based on infection fatality rates and hospital mortality data. Results Our results show that the risk of severe and critical disease increases exponentially with age, but much less steeply than the risk of fatal illness. We also show that our results are consistent across several robustness checks. Conclusion A complete evaluation of the risks of SARS-CoV-2 for health must take non-fatal disease outcomes into account, particularly in young populations where they can be 2 orders of magnitude more frequent than deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07262-0.
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Affiliation(s)
- Daniel Herrera-Esposito
- Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay. .,Centro Interdisciplinario de Ciencia de Datos y Aprendizaje Automático, Universidad de la República, Montevideo, Uruguay.
| | - Gustavo de Los Campos
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.,Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA.,Institute for Quantitative Health Science and Engineering, East Lansing, MI, USA
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22
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Driansky A, Pilapil M, Bianco K, Steinway C, Feigenbaum S, Yang A, Jan S. Caring for Children With Medical Complexity in the Early COVID-19 Pandemic in an Ambulatory Primary Care Setting. Front Pediatr 2022; 10:813393. [PMID: 35223695 PMCID: PMC8864108 DOI: 10.3389/fped.2022.813393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children with medical complexity (CMC) have multiple chronic conditions and require a high level of coordinated healthcare. The risk of COVID-19 among CMC is unclear. OBJECTIVES We aim to identify and describe the prevalence and experience of COVID-19 among CMC and their caregivers during the initial weeks of the COVID-19 pandemic in the NY metropolitan area. METHODS We performed a cross-sectional study of children enrolled in a structured clinical program for CMC at a large urban, academic general pediatrics practice in NY. RESULTS In our patient population (n = 132), 16 patients had a known exposure with parents being the most common exposure in 37.5% (n = 6). Two patients were hospitalized for COVID-19 while the remainder of the confirmed or suspected COVID-19 cases were managed as an outpatient. CONCLUSIONS Common sources of COVID-19 exposure were family members and home care providers. Almost all of our patients experienced interruption of medical care including missed therapies and visits.
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Affiliation(s)
- Allison Driansky
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, NY, United States
| | - Mariecel Pilapil
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, NY, United States
| | - Kristina Bianco
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
| | - Caren Steinway
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, NY, United States
| | - Sheri Feigenbaum
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
- South Shore University Hospital, Northwell Health, Bay Shore, NY, United States
| | - Anna Yang
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sophia Jan
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, NY, United States
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23
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Jackson WM, Price JC, Eisler L, Sun LS, Lee JJ. COVID-19 in Pediatric Patients: A Systematic Review. J Neurosurg Anesthesiol 2022; 34:141-147. [PMID: 34870638 DOI: 10.1097/ana.0000000000000803] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/21/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The coronavirus disease (COVID)-19 pandemic has been an enormous global health burden, resulting in hundreds of millions of documented infections and more than 3 million deaths. Increasing reports characterizing the effects of COVID-19 in pediatric populations have been published during the course of the pandemic. We performed a systematic review to assess the scope of diagnosis, treatment, and management of COVID-19 in pediatric patients. MATERIALS AND METHODS We searched the Cochrane Database of Systematic Reviews, PubMed, CINAHL, and Embase for studies published between January 1, 2020, and May 1, 2021. Each result was screened by 2 authors independently, and discordant findings were adjudicated by a third party. Data extracted included demographic data, symptom data, and clinical data including mortality, severe illness, laboratory data, radiologic data, and treatment. Bias assessment was performed using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. RESULTS We found a total of 16,266 search results, and we accepted 63 manuscripts into the review. The quality of evidence was low. It was difficult to estimate the risk of mortality in pediatric patients with COVID-19 given the quality of the evidence, but overall it is likely below 1%. The most common symptoms in symptomatic pediatric COVID-19 patients were fever (58%) and cough (50%). There was a high proportion of asymptomatic infection (65%). DISCUSSION Pediatric COVID-19 infection is mild and frequently asymptomatic. There is a low risk of severe illness or death in children who contract COVID-19. High-quality studies should be conducted to develop best practices for prevention, diagnosis, and management of symptomatic illness.
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Affiliation(s)
| | | | | | - Lena S Sun
- Departments of Anesthesiology
- Pediatrics, Columbia University, New York, NY
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24
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Pérez López P, Carvajal Duque D, Salgado García DM, Vega Vega MR, Ramos-Castaneda JA, Ardila Gómez IJ, Romero AF. Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience. Front Pediatr 2022; 10:838922. [PMID: 35450106 PMCID: PMC9016331 DOI: 10.3389/fped.2022.838922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. OBJECTIVE To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. METHODS Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. RESULTS We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. CONCLUSION This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.
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Affiliation(s)
- Pilar Pérez López
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | - Darling Carvajal Duque
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | | | - Martha Rocío Vega Vega
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | | | - Iván José Ardila Gómez
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | - Andrés Felipe Romero
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
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25
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High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru. Pediatr Res 2022; 91:1730-1734. [PMID: 33941862 PMCID: PMC8090521 DOI: 10.1038/s41390-021-01547-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/05/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting. METHODS Prospective case-control study that included patients <17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality. Fisher's exact test and the Mann-Whitney U test were used for the analysis. RESULTS Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity. CONCLUSION Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients. IMPACT Pediatric patients with COVID-19 can present with hemorrhagic and ischemic strokes on presentation. Neurological presentation in pediatric patients with COVID-19 has high mortality. Mortality of pediatric patients with COVID-19 is associated with comorbidities. Pediatric presentation and outcomes of COVID-19 in different regions can be novel to previously described.
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26
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Lessa ARD, Bitercourt VN, Crestani F, Andrade GRH, Costa CAD, Garcia PCR. Impact of the COVID-19 Pandemic on Patient- and Family-Centered Care and on the Mental Health of Health Care Workers, Patients, and Families. Front Pediatr 2022; 10:880686. [PMID: 35903168 PMCID: PMC9321398 DOI: 10.3389/fped.2022.880686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
During the COVID-19 pandemic, hospitals around the world were forced to reorganize their processes in an attempt to contain the spread of the virus while still providing adequate care to patients. In the Pediatric Intensive Care Unit (PICU) setting, changes in family visitation protocols and restrictions on parent chaperones during hospitalization, as well as other changes, interfered with care. Based on a narrative review of the literature, supported by the authors' observations in practice, we aimed to describe the impact of the pandemic on patient and family-centered care (PFCC) in the PICU environment, especially regarding the presence of family members, family support, and communication with patients and their families, as well as the effects of changes in these practices on the mental health of those involved. In this context, several strategies were used to sustain PFCC, and, despite many challenges, attempts were made to achieve the bare-minimum goals of humanized care for patients, families, and providers alike.
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Affiliation(s)
- Alessandra Rodrigues Dias Lessa
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Victória Noremberg Bitercourt
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Francielly Crestani
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gabriela Rupp Hanzen Andrade
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Caroline Abud Drumond Costa
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pedro Celiny Ramos Garcia
- Graduate Program in Pediatrics and Child Health, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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27
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Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2021; 9:children9010003. [PMID: 35053628 PMCID: PMC8774577 DOI: 10.3390/children9010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/27/2022]
Abstract
Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such reviews have not yet been published for children and adolescents. We describe the results of a systematic review for intrinsic kidney pathology following COVID-19 infection in children and adolescents. Methods: A systematic literature search of published data up until 31 October was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Research articles reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following acute COVID-19 infection were included for qualitative review. COVID-19 infection status was defined by a positive result from a RT-PCR, or nuclear antibody testing. Only full-text articles published in the English language were selected for review. Results: Twenty-nine cases from fifteen articles were included in the qualitative synthesis of this systematic review. Nephrotic syndrome, as an umbrella condition, appeared as the most frequently observed presentation (20 cases) with disease remission noted in all cases with steroid treatment. Other cases included numerous glomerulonephritides, such as acute necrotizing glomerulonephritis, MPO vasculitis and collapsing glomerulopathy, and thrombotic microangiopathies, such as aHUS. For patients with transplanted kidneys, T-cell-mediated rejection and mild tubular interstitial infiltration were noted following testing positive for COVID-19. There were no mortalities reported in any of the included cases, although two patients remained dialysis dependent at hospital discharge. Conclusion: This systematic review highlights the various intrinsic pathological kidney manifestations in children and adolescents as a result of acute COVID-19 infection. The clinical timeline and presentation of these cases support the mechanistic hypothesis between COVID-19 infection and the onset of intrinsic kidney pathologies within this context. The progressive introduction of vaccination programs for children and adolescents may hopefully reduce the severity of COVID-19-associated illnesses, and pathological kidney manifestations in this population.
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Ahmed HM, Abd El Kareem RM, Ali FM, Sayed AR, Mohamed YA. Clinical, laboratory, and radiological characteristics of COVID-19-infected children admitted to pediatric intensive care unit: a single-center experience. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2021; 10:79. [PMID: 34805418 PMCID: PMC8590861 DOI: 10.1186/s43088-021-00168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
Background During the second wave of COVID-19, there is an increasing incidence of reported cases in children compared to the early wave. Data on the clinical and laboratory characteristics of COVID-19 in children are evolving, and reports on the characteristics and outcomes of severe COVID-19 in children are still under evaluation. We aimed to describe the clinical, laboratory, and radiological characteristics and outcomes of children with COVID-19 infection admitted to the pediatric intensive care unit (PICU). Results The study included 27 children with COVID-19 infection. Fever, respiratory, and gastrointestinal (GIT) symptoms were predominant presenting symptoms in our patients. The median age of our patients was 9 months (2 m-12 years). Comorbidity was reported in 59.3%. The typical laboratory findings were leukocytosis, lymphopenia, elevated C-reactive proteins levels, and elevated d-dimer levels. The most frequent radiological findings were ground-glass opacities in 100% of patients and bilateral findings in 96%, while cardiomegaly was found in 44% of patients. The multisystem inflammatory syndrome was reported in 33% of patients with GIT symptoms were the most frequent presenting symptoms. Myocarditis was reported in 22% of patients. The mortality rate in this cohort was 14.8%. On multivariate analysis, the only predictor of mortality was the development of MIS-C. Conclusions COVID-19 is more severe in children with comorbid conditions. Fever, respiratory and gastrointestinal (GIT) symptoms were predominant presenting symptoms. MIS-C is of increasing concern in children with high mortality rates. Supplementary Information The online version contains supplementary material available at 10.1186/s43088-021-00168-x.
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Affiliation(s)
- Heba Mostafa Ahmed
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Faten Mohamed Ali
- Department of Radiodiagnosis, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed Reda Sayed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Hendler JV, Miranda do Lago P, Müller GC, Santana JC, Piva JP, Daudt LE. Risk factors for severe COVID-19 infection in Brazilian children. Braz J Infect Dis 2021; 25:101650. [PMID: 34774486 PMCID: PMC8578000 DOI: 10.1016/j.bjid.2021.101650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to describe the epidemiological characteristics and clinical outcome of children hospitalized with COVID-19 and identify the risk factors for severe disease. All hospital admissions of pediatric patients between March and December 2020 in the southern region of Brazil were reviewed and the patients positive for RT-PCR for SARS-CoV-2 were identified. This region encompasses a population of over 2.8 million children and adolescents. Data were extracted from a national database that includes all cases of severe acute respiratory syndrome requiring hospitalization in Brazil. A total of 288 hospitalizations (51.3% female) with a median age of 3 years (interquartile range 0-12 years) were identified. Of these, 38.9% had chronic medical conditions, 55.6% required some form of supplementary oxygen, and 30.2% were admitted to an intensive care unit. There were 17 deaths (5.9%) related to COVID-19. Age less than 30 days was significantly associated with increased odds of critical illness (OR 9.52, 95% CI 3.01-30.08), as well as the presence of one chronic condition (OR 5.08 95%CI 2.78-9.33) or two or more chronic conditions (OR 6.60, 95% CI 3.17-13.74). Conclusion: Age under 30 days old and presence of chronic conditions were strongly associated with unfavorable outcomes in Brazilian children with SARS-CoV-2 infection. These findings could help local public health authorities to develop specific policies to protect this more vulnerable group of children.
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Affiliation(s)
- Jordana Vaz Hendler
- Universidade Federal do Rio Grande do Sul (UFRGS), Child and Adolescent Health, Porto Alegre, RS, Brazil.
| | - Patricia Miranda do Lago
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Gabriel Cardozo Müller
- Universidade Federal do Rio Grande do Sul(UFRGS), Biological Science: Biochemistry, Department of ICBS, Porto Alegre, RS, Brazil
| | - João Carlos Santana
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Jefferson Pedro Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Liane Esteves Daudt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Kortz TB, Connolly E, Cohen CL, Cook RE, Jonas JA, Lipnick MS, Kissoon N. Diagnosis and Acute Management of COVID-19 and Multisystem Inflammatory Syndrome in Children. Pediatr Emerg Care 2021; 37:519-525. [PMID: 34591810 PMCID: PMC8855974 DOI: 10.1097/pec.0000000000002538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT Most children with coronavirus disease 2019 (COVID-19) infection are asymptomatic or have mild disease. About 5% of infected children will develop severe or critical disease. Rapid identification and treatment are essential for children who are critically ill with signs and symptoms of respiratory failure, septic shock, and multisystem inflammatory syndrome in children. This article is intended for pediatricians, pediatric emergency physicians, and individuals involved in the emergency care of children. It reviews the current epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children, summarizes key aspects of clinical assessment including identification of high-risk patients and manifestations of severe disease, and provides an overview of COVID-19 management in the emergency department based on clinical severity.
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Affiliation(s)
| | | | | | | | - Jennifer A Jonas
- Resident in Pediatrics, Department of Pediatrics, Weill Cornell Medicine, New York City, NY
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Sethi SK, Rana A, Adnani H, McCulloch M, Alhasan K, Sultana A, Safadi R, Agrawal N, Raina R. Kidney involvement in multisystem inflammatory syndrome in children: a pediatric nephrologist's perspective. Clin Kidney J 2021; 14:2000-2011. [PMID: 34471522 PMCID: PMC8083308 DOI: 10.1093/ckj/sfab073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Indexed: 12/28/2022] Open
Abstract
The initial report of the multisystem inflammatory syndrome in children (MIS-C) was from the UK in April 2020; since then, cases have been reported worldwide. Renal involvement has been seen commonly, ranging from 10% to 46%. Kidney involvement following severe acute respiratory syndrome coronavirus 2 infection in children with MIS-C is more common than initially thought and is associated with higher morbidity and mortality. There are several reports of a direct viral tropism of coronavirus disease 2019 and MIS-C-associated renal damage. This study’s objective was to systematically review the current understanding of kidney involvement in children suffering from MIS-C. Based on our systemic literature search, 19 studies have either partially or fully discussed kidney involvement in MIS-C patients. Furthermore, we discuss the multifactorial pathogenesis contributing to acute kidney injury (AKI) development in MIS-C. The current review gives a pediatric nephrologist’s perspective of the renal involvement in MIS-C, the incidence of AKI, the pathophysiology of AKI in MIS-C and the proposed therapeutic regimens available, including the need for kidney replacement therapy for a child with AKI associated with MIS-C. As the disease is rapidly evolving, more detailed clinical prospective studies are required to understand MIS-C and its role in AKI better.
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Affiliation(s)
- Sidharth Kumar Sethi
- Division of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Abhyuday Rana
- Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Harsha Adnani
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Mignon McCulloch
- Department of Renal and Organ Transplant, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azmeri Sultana
- Pediatric Nephrology, M R Khan Children Hospital, and Institute of Child Health, Dhaka, Bangladesh
| | - Rama Safadi
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Nirav Agrawal
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
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Grewal MK, Gregory MJ, Jain A, Mohammad D, Cashen K, Ang JY, Thomas RL, Valentini RP. Acute Kidney Injury in Pediatric Acute SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children (MIS-C): Is There a Difference? Front Pediatr 2021; 9:692256. [PMID: 34434905 PMCID: PMC8380850 DOI: 10.3389/fped.2021.692256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To evaluate the prevalence and factors associated with the risk of acute kidney injury (AKI) in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C). Study Design: We performed a retrospective chart review of 113 patients with SARS-CoV-2 infection with or without MIS-C admitted at Children's Hospital of Michigan (CHM) from March to August 2020. Patient demographic details, laboratory data, imaging studies, echocardiography reports, and treatment data were collected. Results: Of the 92 patients included in the final analysis, 22 (24%) developed AKI with 8/22 (36%) developing stage 3 AKI. The prevalence of AKI was much higher in patients with MIS-C 15/28 (54%) vs. those with acute SARS-CoV-2 infection 7/64 (11%), (p < 0.001). Overall, when compared to patients without AKI, patients with AKI were older in age (11 vs. 6.5 years, p = 0.007), African American (86 vs. 58%, p = 0.028), had MIS-C diagnosis (68 vs. 19%, p < 0.001), required ICU admission (91 vs. 20%, p < 0.001), had cardiac dysfunction (63 vs. 16%, p < 0.001), required inotropic support (59 vs. 6%, p < 0.001) and had a greater elevation in inflammatory markers. In a multivariate analysis, requirement of inotropes [Odds Ratio (OR)-22.8, p < 0.001], African American race (OR-8.8, p = 0.023) and MIS-C diagnosis (OR-5.3, p = 0.013) were the most significant predictors for AKI. All patients had recovery of kidney function, and none required kidney replacement therapy. Conclusion: Children with acute SARS-CoV-2 infection and MIS-C are at risk for AKI, with the risk being significantly greater with MIS-C. The pathogenesis of AKI in acute SARS-CoV-2 infection appears to be a combination of both renal hypo-perfusion and direct renal parenchymal damage whereas in MIS-C, the renal injury appears to be predominantly pre-renal from cardiac dysfunction and capillary leak from a hyperinflammatory state. These factors should be considered by clinicians caring for these children with a special focus on renal protective strategies to aid in recovery and prevent additional injury to this high-risk subgroup.
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Affiliation(s)
- Manpreet K. Grewal
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Melissa J. Gregory
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Amrish Jain
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Dunya Mohammad
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Katherine Cashen
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
| | - Jocelyn Y. Ang
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ronald L. Thomas
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
| | - Rudolph P. Valentini
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI, United States
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Affiliation(s)
- Philip P Knight
- Pediatric Intensive Care Unit, King's College Hospital, London, UK
| | - Akash Deep
- Pediatric Intensive Care Unit, King's College Hospital, London, UK.
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Zee-Cheng JE, McCluskey CK, Klein MJ, Scanlon MC, Rotta AT, Shein SL, Pineda JA, Remy KE, Carroll CL. Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic. Chest 2021; 160:529-537. [PMID: 33727033 PMCID: PMC7954775 DOI: 10.1016/j.chest.2021.03.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children have been less affected by the COVID-19 pandemic, but its repercussions on pediatric illnesses may have been significant. This study examines the indirect impact of the pandemic on a population of critically ill children in the United States. RESEARCH QUESTION Were there significantly fewer critically ill children admitted to PICUs during the second quarter of 2020, and were there significant changes in the types of diseases admitted? STUDY DESIGN AND METHODS This retrospective observational cohort study used the Virtual Pediatric Systems database. Participants were 160,295 children admitted to the PICU at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017 to 2019 (pre-COVID-19) and 2020 (COVID-19). RESULTS The average number of admissions was similar between pre-COVID-19 Q1 and COVID-19 Q1 but decreased by 32% from pre-COVID-19 Q2 to COVID-19 Q2 (20,157 to 13,627 admissions per quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID-19 Q2 (6.6% of patients) vs 241 subjects in COVID-19 Q2 (1.8%; P < .001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; P < .001). The percentage of trauma admissions increased, although the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID-19 Q2 increased compared with pre-COVID-19 Q2 (OR, 1.165; 95% CI, 1.00-1.357; P = .049). INTERPRETATION Pediatric critical illness admissions decreased substantially during the second quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.
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Affiliation(s)
- Janine E Zee-Cheng
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
| | - Casey K McCluskey
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Matthew C Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Alexandre T Rotta
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Steven L Shein
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Jose A Pineda
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kenneth E Remy
- Departments of Pediatrics and Internal Medicine, Washington University in St. Louis, St. Louis, MO
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Díaz F, Cores C, Atenas O, Rodríguez N, Bustos R, Cruces P. Rationale of Therapeutic Plasma Exchange as Rescue Immunomodulatory Treatment for MIS-C With Multiorgan Failure. Pediatr Infect Dis J 2021; 40:e259-e262. [PMID: 34097663 DOI: 10.1097/inf.0000000000003169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection is an infrequent and poorly understood illness. It can present as severe multiorgan failure in children, potentially lethal. Immunomodulation is the empiric treatment because a dysregulated immune response is the primary pathophysiologic mechanism. We present an infant with severe MIS-C, refractory to usual treatment, successfully treated with plasmapheresis.
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Affiliation(s)
- Franco Díaz
- From the Hospital El Carmen de Maipú, Unidad de Paciente Crítico Pediátrico, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Camila Cores
- From the Hospital El Carmen de Maipú, Unidad de Paciente Crítico Pediátrico, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
| | - Omar Atenas
- Hospital El Carmen de Maipú, Unidad de Diálisis, Santiago, Chile
| | - Nicolás Rodríguez
- Hospital El Carmen de Maipú, Unidad de Medicina Transfusional, Santiago, Chile
| | - Raúl Bustos
- Clínica Sanatorio Alemán, Unidad de Cuidados Intensivos Pediátricos, Concepción, Chile
| | - Pablo Cruces
- From the Hospital El Carmen de Maipú, Unidad de Paciente Crítico Pediátrico, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Centro de Investigación de Medicina Veterinaria, Universidad Andres Bello, Santiago, Chile
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Boudhabhay I, Rabant M, Roumenina LT, Coupry LM, Poillerat V, Marchal A, Frémeaux-Bacchi V, El Karoui K, Monchi M, Pourcine F. Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy. Front Immunol 2021; 12:680567. [PMID: 34248962 PMCID: PMC8260674 DOI: 10.3389/fimmu.2021.680567] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. A clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after SARS-CoV-2 infection, have been described in children (MIS-C) and adults (MIS-A), but the pathophysiology remains unknown. CASE PRESENTATION We describe a case of post-COVID-19 MIS-A in a 46-year-old man with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with eculizumab was initiated promptly and led to a dramatic improvement of renal function. CONCLUSION Our case suggests that that TMA could play a central role in the pathophysiology of post-COVID-19 MIS-A, making complement blockers an interesting therapeutic option.
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Affiliation(s)
- Idris Boudhabhay
- Groupe Hospitalier Sud Ile de France, Service de Réanimation, Melun, France
- Centre Hospitalo-Universitaire Necker, Service d’Anatomie Pathologique, Paris, France
| | - Marion Rabant
- Centre Hospitalo-Universitaire Necker, Service d’Anatomie Pathologique, Paris, France
| | - Lubka T. Roumenina
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Louis-Marie Coupry
- Groupe Hospitalier Sud Ile de France, Service de Réanimation, Melun, France
| | - Victoria Poillerat
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Armance Marchal
- Hôpital Européen Georges Pompidou, Laboratoire d’Immunologie Biologique, Paris, France
| | | | - Khalil El Karoui
- Centre Hospitalo-Universitaire Henri Mondor, Service de Néphrologie et Transplantation, Créteil, France
| | - Mehran Monchi
- Groupe Hospitalier Sud Ile de France, Service de Réanimation, Melun, France
| | - Franck Pourcine
- Groupe Hospitalier Sud Ile de France, Service de Réanimation, Melun, France
- Groupe Hospitalier Sud Ile de France, Service de Néphrologie, Melun, France
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Cobb MJ. Just Breathe: Tips and Highlights for Managing Pediatric Respiratory Distress and Failure. Emerg Med Clin North Am 2021; 39:493-508. [PMID: 34215399 DOI: 10.1016/j.emc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.
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Affiliation(s)
- Megan J Cobb
- University of Maryland School of Medicine, Department of Emergency Medicine; Maryland Emergency Medicine Network, Upper Chesapeake Emergency Medicine, 500 Upper Chesapeake Dr, Bel Air, MD 21014, USA.
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38
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Acute kidney injury in children with COVID-19: a retrospective study. BMC Nephrol 2021; 22:202. [PMID: 34059010 PMCID: PMC8165516 DOI: 10.1186/s12882-021-02389-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission. Methods This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results Of 89 children included, 19 (21 %) developed AKI (52.6 % stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15 % vs. 1.5 %). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32 % vs. 2.8 %, p < 0.001) and mortality (42 % vs. 0 %, p < 0.001). However, AKI was not associated with prolonged hospitalization (58 % vs. 40 %, p = 0.163) or development of MIS-C (10.5 % vs. 1.4 %, p = 0.051). No patient in the AKI group required renal replacement therapy. Residual renal impairment at discharge occurred in 9 % of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture. Conclusions AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.
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Lima-Setta F, Magalhães-Barbosa MCD, Rodrigues-Santos G, Figueiredo EADN, Jacques MDL, Zeitel RDS, Sapolnik R, Borges CTDS, Lanziotti VS, Castro REVD, Bellinat APN, Silva TPD, Oliveira FRCD, Reis BCSD, Castro NADASR, Macedo JHGC, Scarlato ACCP, Riveiro PM, Mota ICFD, Lorenzo VB, Lucena NMLD, Azevedo ZMAD, Cunha AJLA, Prata-Barbosa A. Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study. J Pediatr (Rio J) 2021; 97:354-361. [PMID: 33186512 PMCID: PMC7649656 DOI: 10.1016/j.jped.2020.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. METHOD Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. RESULTS Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%). CONCLUSIONS Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.
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Affiliation(s)
- Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Instituto Fernandes Figueira, Unidade de Pacientes Graves, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Gustavo Rodrigues-Santos
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | | | - Melissa de Lorena Jacques
- Pediatric ICU, Hospital Quinta D'Or, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio José L A Cunha
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Graff K, Smith C, Silveira L, Jung S, Curran-Hays S, Jarjour J, Carpenter L, Pickard K, Mattiucci M, Fresia J, McFarland EJ, Dominguez SR, Abuogi L. Risk Factors for Severe COVID-19 in Children. Pediatr Infect Dis J 2021; 40:e137-e145. [PMID: 33538539 DOI: 10.1097/inf.0000000000003043] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are limited pediatric data regarding severe COVID-19 disease. Our study aims to describe the epidemiology and identify risk factors for severe COVID-19 disease in children. METHODS This is a retrospective cohort study among children with positive SARS-CoV-2 PCR from March to July 2020 at Children's Hospital Colorado. Risk factors for severe disease were analyzed as defined by hospital admission, respiratory support, or critical care. Univariable and multivariable analyses were conducted. RESULTS Among 454 patients identified with SARS-CoV-2, 191 (42.1%) were females, median age 11 years. Fifty-five percent of all patients identified as Hispanic compared with 29% among all hospital visits in 2019 (P < 0.0001). In multivariable analyses, age 0-3 months or >20 years [adjusted odds ratio (aOR), 7.85; P < 0.0001 and aOR, 5.1; P = 0.03, respectively], preterm birth history (aOR, 3.7; P = 0.03), comorbidities [including immunocompromise (aOR, 3.5; P = 0.004), gastrointestinal condition (aOR, 2.7; P = 0.009), diabetes (aOR, 6.6; P = 0.04), asthma (aOR, 2.2; P = 0.04)], and specific symptoms at presentation were predictors for admission. Age 0-3 months or >20 years, asthma, gastrointestinal condition, and similar symptoms at presentation were also predictors for respiratory support. Elevated C-reactive protein was associated with the need for critical care with median of 17.7 mg/dL (IQR, 5.3-22.9) versus 1.95 mg/dL (IQR, 0.7-5.5) among patients requiring critical versus no critical care (OR, 1.2; P = 0.02). CONCLUSIONS Extremes of age, comorbid conditions, and elevated CRP are predictors of severe disease in children. Findings from this study can inform pediatric providers and public health officials to tailor clinical management, pandemic planning, and resource allocation.
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Affiliation(s)
- Kelly Graff
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Christiana Smith
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Lori Silveira
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Sarah Jung
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO
| | - Shane Curran-Hays
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Jane Jarjour
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | | | - Kasey Pickard
- University of Colorado School of Medicine, Aurora, CO
| | - Michael Mattiucci
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | | | | | - Samuel R Dominguez
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO
| | - Lisa Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
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Characteristics of Severe Acute Respiratory Syndrome Coronavirus-2 Infection and Comparison With Influenza in Children Admitted to U.K. PICUs. Crit Care Explor 2021; 3:e0362. [PMID: 33786438 PMCID: PMC7994042 DOI: 10.1097/cce.0000000000000362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Severe acute respiratory syndrome coronavirus-2 affects adults disproportionately more than children. A small proportion of children with severe acute respiratory syndrome coronavirus-2 required admission to a PICU. We describe the nationwide U.K. PICU experience of severe acute respiratory syndrome coronavirus-2 infection during the first wave of the pandemic and compare this with the critical care course of the 2019 influenza cohort. Design: Prospective nationwide cohort study of characteristics of severe acute respiratory syndrome coronavirus-2–positive children. Data collection utilized routine Pediatric Intensive Care Audit Network and severe acute respiratory syndrome coronavirus-2–specific data. Setting: All U.K. PICUs. Patients: Children less than 18 years old, admitted to U.K. PICUs between March 14, 2020, and June 13, 2020, and a positive severe acute respiratory syndrome coronavirus-2 polymerase chain reaction. Children admitted to U.K. PICUs in 2019 with influenza provided comparison. Interventions: None. Measurements and Main Results: We identified 76 PICU admissions among 73 children with a positive severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test. Prevalence of PICU admissions per million was 5.2 for children versus 260 for adults. Ten children (14%) were identified on routine screening. Seventeen children (23%) had pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. Seventeen (23%) had coinfections. Invasive ventilation was required in seven of 17 children (41%) with pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 versus 38 of 56 other severe acute respiratory syndrome coronavirus-2 positive children (68%), with 77% requiring vasoactive support versus 43%, respectively. Seven children (10%) died. In comparison with influenza children, severe acute respiratory syndrome coronavirus-2 children were older (median [interquartile range]: 10 [1–13] vs 3 yr [1–8 yr]), more often Black or Asian (52% v 18%), higher weight z score (0.29 [–0.80 to 1.62] vs –0.41 [–1.37 to 0.63]), and higher deprivation index (3.3 [–1 to 6.3] vs 1.2 [–1.8 to 4.4]). Comorbidities, frequency of organ supports, and length of stay were similar. Conclusions: This nationwide study confirms that PICU admissions with severe acute respiratory syndrome coronavirus-2 infections were infrequent. We have reported similarities and differences in sociodemographic characteristics, organ support interventions, and outcomes of children affected by severe acute respiratory syndrome coronavirus-2 compared with influenza.
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Gilpin S, Byers M, Byrd A, Cull J, Peterson D, Thomas B, Jacobson P. Rhabdomyolysis as the Initial Presentation of SARS-CoV-2 in an Adolescent. Pediatrics 2021; 147:peds.2020-019273. [PMID: 33037123 DOI: 10.1542/peds.2020-019273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
The novel coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has created a global pandemic, with many cases affecting the elderly. However, children have been affected as well, with ∼2.4% to 3.7% of cases reported. This case is the first published case of an adolescent presenting with rhabdomyolysis as the first sign of novel coronavirus disease 2019, with extremely elevated creatinine kinase levels, approaching almost 400 000 U/L. This case adds to the growing body of literature of a variety of life-threatening manifestations associated with severe acute respiratory syndrome coronavirus 2 infection and highlights the importance of how prompt recognition of these unique presentations of the disease is important to mitigate complications.
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Affiliation(s)
- Shawnese Gilpin
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois;
| | - Michael Byers
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Allison Byrd
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Jennifer Cull
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Danielle Peterson
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; and
| | - Bettina Thomas
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Phillip Jacobson
- Department of Pediatrics, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.,Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
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Fernández-Sarmiento J, De Souza D, Jabornisky R, Gonzalez GA, Arias López MDP, Palacio G. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee. BMJ Paediatr Open 2021; 5:e000894. [PMID: 34192188 PMCID: PMC7868133 DOI: 10.1136/bmjpo-2020-000894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background In this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries. Methods A systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020. Results A total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources. Conclusions PIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent-but not exclusive-digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Critical Care Medicine and Pediatrics Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Bogotá, Colombia
| | - Daniela De Souza
- Pediatric Intensive Care Unit and Department of Pediatrics, Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Sao Paulo, Brazil
| | - Roberto Jabornisky
- Department of Pediatrics Facultad de Medicina Universidad Nacional del Nordeste, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Corrientes, Argentina
| | - Gustavo Ariel Gonzalez
- Pediatric Intensive Care Unit. Hospital Churruca - Visca Medical Complex, Ricardo Gutiérrez Children’s Hospital, Sepsis Committee. Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
| | - Maria del Pilar Arias López
- Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
| | - Gladys Palacio
- Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Sepsis Committee. Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
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Sinaei R, Pezeshki S, Parvaresh S, Sinaei R. Why COVID-19 is less frequent and severe in children: a narrative review. World J Pediatr 2021; 17:10-20. [PMID: 32978651 PMCID: PMC7518650 DOI: 10.1007/s12519-020-00392-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the streaks of severity, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is, in general, less frequent and severe in children than in adults. We searched for causal evidence of this mystery. DATA SOURCES An extensive search strategy was designed to identify papers on coronavirus disease 2019 (COVID-19). We searched Ovid MEDLINE, PubMed, EMBASE databases, and Cochrane library and carried out a review on the causes of this dilemma. RESULTS Our searches produced 81 relevant articles. The review showed that children accounted for a lower percentage of reported cases, and they also experienced less severe illness courses. Some potential explanations, including the tendency to engage the upper airway, the different expression in both receptors of angiotensin-converting enzyme and renin-angiotensin system, a less vigorous immune response, the lower levels of interleukin (IL)-6, IL-10, myeloperoxidase, and P-selectin and a higher intracellular adhesion molecule-1, a potential protective role of lymphocytes, and also lung infiltrations might have protective roles in the immune system-respiratory tract interactions. Finally, what have shed light on this under representation comes from two studies that revealed high-titer immunoglobulin-G antibodies against respiratory syncytial virus and mycoplasma pneumonia, may carry out cross-protection against SARS-CoV-2 infection, just like what suggested about the vaccines. CONCLUSIONS These results require an in-depth look. Properties of the immune system including a less vigorous adaptive system beside a preliminary potent innate response and a trained immunity alongside a healthier respiratory system, and their interactions, might protect children against SARS-CoV-2 infection. However, further studies are needed to explore other possible causes of this enigma.
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Affiliation(s)
- Reza Sinaei
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Saeedeh Parvaresh
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Sinaei
- Department of Pediatrics, School of Medicine, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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45
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Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M, Juárez-Villegas L, Márquez-González H. Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis. Front Oncol 2021; 10:608282. [PMID: 33552980 PMCID: PMC7861039 DOI: 10.3389/fonc.2020.608282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all age groups, including the pediatric population, in 3–5% of all cases. We performed a meta-analysis to understand the survival and associated complications in pediatric cancer patients as well as their hospitalization, intensive care, and ventilation care (supplemental oxygen/endotracheal intubation) needs. Methods A systematic search was performed using MEDLINE, TRIP Database, International Clinical Trials Registry Platform (WHO), The Cochrane Library, Wiley, LILACS, and Google Scholar. Additionally, a search using the snowball method was performed in Nature, New England Journal of Medicine, Science, JAMA, ELSEVIER editorial, Oxford University Press, The Lancet, and MedRxiv. Searches were conducted until July 18, 2020. A total of 191 cancer patients with coronavirus disease 2019 (COVID-19) were integrated from 15 eligible studies. In a sub-analysis, patients were stratified into two groups: hematological cancer and solid tumors. Outcome measures were overall survival, risk of hospitalized or needing intensive care, and need for ventilatory support in any modality. The random effects statistical analysis was performed with Cochran’s chi square test. The odds ratio (OR) and heterogeneity were calculated using the I2 test. Results The overall survival was 99.4%. There were no statistically significant differences in the risk of hospitalization between hematological malignancies and solid tumors (95% confidence interval [CI] 0.48–18.3; OR = 2.94). The risk of being admitted to the intensive care unit was also not different between hematological malignancies and other tumors (95% CI 0.35–5.81; OR = 1.42). No differences were found for the need of ventilatory support (95% CI 0.14–3.35; OR = 0.68). Although all the studies were cross-sectional, the mortality of these patients was 0.6% at the time of analysis. Conclusions In the analyzed literature, survival in the studied group of patients with COVID-19 was very high. Suffering from hematological neoplasia or other solid tumors and COVID-19 was not a risk factor in children with cancer for the analyzed outcomes.
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Affiliation(s)
- Elisa Dorantes-Acosta
- Biobanco de Investigación en Células Leucémicas, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Diana Ávila-Montiel
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Luis Juárez-Villegas
- Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.,Cardiopatías Congénitas. Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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Abstract
BACKGROUND To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.
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47
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Raina R, Chakraborty R, Mawby I, Agarwal N, Sethi S, Forbes M. Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit. Pediatr Nephrol 2021; 36:2627-2638. [PMID: 33928439 PMCID: PMC8083920 DOI: 10.1007/s00467-021-05084-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES COVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents. METHODS A comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes. RESULTS Twenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%. CONCLUSION AKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA. .,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA. .,School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ronith Chakraborty
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA ,Department of Nephrology, Akron Children’s Hospital, Akron, OH USA
| | - Isabelle Mawby
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA
| | - Nirav Agarwal
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana India
| | - Michael Forbes
- Director of Clinical Research and Outcomes Analysis, Department of Pediatrics, Akron Children’s Hospital, Akron, OH USA
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48
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Olivini N, Calò Carducci FI, Santilli V, De Ioris MA, Scarselli A, Alario D, Geremia C, Lombardi MH, Marabotto C, Mariani R, Papa RE, Peschiaroli E, Scrocca R, Sinibaldi S, Smarrazzo A, Stella P, Bernardi S, Chiurchiù S, Pansa P, Romani L, Michaela C, Concato C, De Rose DU, Salvatori G, Rossi P, Villani A, Dotta A, D'Argenio P, Campana A. A neonatal cluster of novel coronavirus disease 2019: clinical management and considerations. Ital J Pediatr 2020; 46:180. [PMID: 33287880 PMCID: PMC7720265 DOI: 10.1186/s13052-020-00947-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lately, one of the major clinical and public health issues has been represented by Coronavirus disease of 2019 (COVID-19) during pregnancy and the risk of transmission of the infection from mother to child. Debate on perinatal management and postnatal care is still ongoing, principally questioning the option of the joint management of mother and child after birth and the safety of breastfeeding. According to the available reports, neonatal COVID-19 appears to have a horizontal transmission and seems to be paucisymptomatic or asymptomatic, compared to older age groups. The aim of this work is to describe a cluster of neonatal COVID-19 and discuss our experience, with reference to current evidence on postnatal care and perinatal management. METHODS This is a retrospective observational case series of five mother-child dyads, who attended the Labor and Delivery Unit of a first-level hospital in Italy, in March 2020. Descriptive statistics for continuous variables consisted of number of observations, mean and the range of the minimum and maximum values. RESULTS Five women and four neonates tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In one case, the mother-child dyad was separated and the neonate remained negative on two consecutive tests. Two positive neonates developed symptoms, with a predominant involvement of the gastrointestinal tract. Blood tests were unremarkable, except for a single patient who developed mild neutropenia. No complications occurred. CONCLUSIONS We agree that the decision on whether or not to separate a positive/suspected mother from her child should be made on an individual basis, taking into account the parent's will, clinical condition, hospital logistics and the local epidemiological situation. In conformity with literature, in our study, affected neonates were asymptomatic or paucisymptomatic. Despite these reassuring findings, a few cases of severe presentation in the neonatal population have been reported. Therefore, we agree on encouraging clinicians to monitor the neonates with a suspected or confirmed infection.
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Affiliation(s)
- Nicole Olivini
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
| | - Francesca Ippolita Calò Carducci
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Veronica Santilli
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Maria Antonietta De Ioris
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Alessia Scarselli
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Dario Alario
- Pediatrics and Neonatology Unit, San Paolo Hospital, Civitavecchia, Italy
| | - Caterina Geremia
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Mary Haywood Lombardi
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Caterina Marabotto
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Rosanna Mariani
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Raffaele Edo Papa
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Emanuela Peschiaroli
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Raffaella Scrocca
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Serena Sinibaldi
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Andrea Smarrazzo
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Pietro Stella
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
| | - Stefania Bernardi
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Sara Chiurchiù
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Paola Pansa
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Lorenza Romani
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Carletti Michaela
- Laboratory Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Carlo Concato
- Virology Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Gugliemo Salvatori
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Paolo Rossi
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Villani
- Pediatrics and Infectious Diseases Unit, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Andrea Dotta
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Patrizia D'Argenio
- Research Unit in Congenital and Perinatal Infection, Immune and Infectious Diseases Division, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Andrea Campana
- Pediatrics Unit, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital - IRCCS, Via della Torre di Palidoro, 00050, Fiumicino, Rome, Italy
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A Cytokine Circus with a Viral Ringleader: SARS-CoV-2-Associated Cytokine Storm Syndromes. Trends Mol Med 2020; 26:1078-1085. [PMID: 33051104 PMCID: PMC7524648 DOI: 10.1016/j.molmed.2020.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
An unbridled host immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to underlie severe cases of the disease and has been labeled a 'cytokine storm syndrome' (CSS). Here, we emphasize that categorization of syndromes triggered by a completely novel pathogen based on other seemingly similar, but potentially distinct, known entities is an inherently risky endeavor.
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Torres Viñas VR, Fernández Sarmiento J, Mulett Hoyos H, Acevedo Sedano L, Vásquez Hoyos P, Sarmiento MP, Pardo R, Fernández Laverde M, Piñeres Olave B, López Alarcón Y, Tamayo C, Jaramillo Bustamante JC, Lasso R, Agudelo MT, Orozco Marún R, Mazzilli Vega L, Zemanate Zúñiga E, Nieto Estrada VH. Declaración consenso de la Asociación Colombiana de Medicina Crítica y Cuidados Intensivos (AMCI) para atención y manejo del paciente pediátrico con sospecha o confirmación de infección severa por SARS-CoV-2. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2020. [PMCID: PMC7538131 DOI: 10.1016/j.acci.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Una nueva pandemia fue declarada por la Organización Mundial de la Salud por el virus SARS-CoV-2 recientemente. Este virus se caracteriza por ser altamente transmisible, letal y afectar a todos los grupos etarios. Esta declaración permitió la activación en todos los países de mecanismos de urgencia para atender esta crisis de salud pública que ha expuesto las debilidades de los sistemas de salud y el déficit de camas de cuidado intensivo adulto (UCIA) y pediátrico (UCIP). Colombia tiene un número reducido de camas de UCIP con respecto a otros países de medianos y bajos ingresos. Por esta razón, debemos optimizar los recursos, anticiparse a los casos graves y conocer el comportamiento de la enfermedad por el virus del SARS-CoV-2 (llamada COVID-19) en pediatría, especialmente en las formas severas de presentación en niños. La severidad y grado de afectación por el virus en todos los países ha sido muy similar con una mayor gravedad y frecuencia de infección en la población adulta, particularmente en personas mayores de 60 años y con comorbilidades (obesidad, hipertensión, diabetes, entre otros). No obstante, también se ha registrado en la población pediátrica casos graves que requieren intervenciones avanzadas en terapia intensiva, incluyendo una forma de presentación con gran respuesta inflamatoria en niños denominada síndrome inflamatorio multisistémico (MIS-C por sus siglas en inglés). La Asociación Colombiana de Medicina crítica y Cuidados Intensivos (AMCI) convocó un equipo multidisciplinario de expertos en medicina crítica pediátrica para establecer una declaratoria de consenso de buena práctica clínica para la atención de niños con COVID-19 grave que requieran atención en cuidado intermedio o cuidado intensivo pediátrico. El objetivo de esta declaración de consenso es facilitar y estandarizar la toma de decisiones en los aspectos más relevantes en la atención y realizar un abordaje integral del paciente pediátrico basado en la mejor evidencia disponible y opinión de expertos en cuidado intensivo pediátrico de al menos 10 años de experiencia de trabajo en el área. Adicionalmente, se buscó involucrar a aquellos intensivistas pediatras que deben hacer atención directa de los niños con COVID-19, pertenecen a hospitales de referencia o universitarios y tienen demostrada trayectoria en investigación y docencia en cuidado crítico pediátrico. Esta declaración de consenso se buscará actualizar con la frecuencia que sea necesaria de acuerdo con el cambio de la mejor evidencia disponible, que les permita a los médicos que atienden niños críticos con COVID-19 realizar una atención integral y adecuada acorde con la mejor literatura disponible.
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