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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Calitri C, Fumi I, Ignaccolo MG, Banino E, Benetti S, Lupica MM, Fantone F, Pace M, Garofalo F. Gastrointestinal involvement in paediatric COVID-19 - from pathogenesis to clinical management: A comprehensive review. World J Gastroenterol 2021; 27:3303-3316. [PMID: 34163113 PMCID: PMC8218363 DOI: 10.3748/wjg.v27.i23.3303] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is responsible for the first pandemic of the 21st century. As found in adults, signs and symptoms related to the disease mainly involve the respiratory tract in the paediatric population. However, a considerable number of children present with gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea. The purpose of this review is an accurate description, from pathogenesis to clinical presentation, diagnosis and treatment, of COVID-19 effects on the gastrointestinal system at a paediatric age. SARS-CoV-2 can be identified in stool specimens of affected children by real-time polymerase chain reaction techniques. Positivity can last for several weeks after the end of the symptomatic phase. Gastrointestinal signs and symptoms are generally self-limited, can correlate with blood tests and imaging alterations, and may require supportive treatment such as hydration. However, they can precede severe disease manifestations such as the COVID-19-related multisystem inflammatory syndrome. Children belonging to risk categories such as those affected by celiac disease, inflammatory bowel disease, and hepatic disease seem to not have a more severe course than the others, even if they are undergoing immunosuppressant treatment. Medical follow-ups of patients with chronic diseases need to be revised during the pandemic period in order to postpone unnecessary tests, mainly endoscopic ones.
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Affiliation(s)
- Carmelina Calitri
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Ilaria Fumi
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | | | - Elena Banino
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Stefania Benetti
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | | | - Francesca Fantone
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Mariella Pace
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Franco Garofalo
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
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Abstract
PURPOSE OF REVIEW Pediatric coronavirus disease 2019 (COVID-19) respiratory disease is a distinct entity from adult illness, most notable in its milder phenotype. This review summarizes the current knowledge of the clinical patterns, cellular pathophysiology, and epidemiology of COVID-19 respiratory disease in children with specific attention toward factors that account for the maturation-related differences in disease severity. RECENT FINDINGS Over the past 14 months, knowledge of the clinical presentation and pathophysiology of COVID-19 pneumonia has rapidly expanded. The decreased disease severity of COVID-19 pneumonia in children was an early observation. Differences in the efficiency of viral cell entry and timing of immune recognition and response between children and adults remain at the center of ongoing research. SUMMARY The clinical spectrum of COVID-19 respiratory disease in children is well defined. The age-related differences protecting children from severe disease and death remain incompletely understood.
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Affiliation(s)
- Lea C Steffes
- Division of Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University Medical School, Stanford, California, USA
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Li Q, Zhou Q, Xun Y, Liu H, Shi Q, Wang Z, Zhao S, Liu X, Liu E, Fu Z, Chen Y, Luo Z. Quality and consistency of clinical practice guidelines for treating children with COVID-19. Ann Transl Med 2021; 9:633. [PMID: 33987331 PMCID: PMC8106101 DOI: 10.21037/atm-20-7000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children’s health. Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically. Methods We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed. Results Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22–62%) and 52% (range, 31–89%), respectively. As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19. Conclusions The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.
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Affiliation(s)
- Qinyuan Li
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yangqin Xun
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Zijun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Xiao Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Enmei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.,GIN Asia, Lanzhou, China.,Chinese GRADE Centre, Lanzhou, China.,Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Parisi GF, Indolfi C, Decimo F, Leonardi S, Miraglia del Giudice M. Neumonía por COVID-19 en niños: De su etiología a su manejo. Kompass Neumol 2021. [PMCID: PMC8089434 DOI: 10.1159/000516059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
El COVID-19 es menos serio en niños que en adultos. Sin embargo, las afecciones respiratorias dominan el cuadro clínico de pacientes hospitalizados por COVID-19, aun en niños. En algunas series de casos, el deterioro del estado clínico, donde la disnea, la cianosis y el inicio del síndrome de dificultad respiratoria aguda (SDRA) emergieron ∼8–10 días después del inicio de la infección por SARS-CoV-2, pudo progresar rápidamente hasta la falla multiorgánica y la muerte. Esta revisión tiene como objetivo evaluar las características de la neumonía por COVID-19 en poblaciones pediátricas, comenzando con su etiología y sus mecanismos patológicos, para cerrar con su manejo clínico.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Departamento de Medicina Clínica y Experimental, Universidad de Catania, Catania, Italia
| | - Cristiana Indolfi
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | - Fabio Decimo
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | - Salvatore Leonardi
- Departamento de Medicina Clínica y Experimental, Universidad de Catania, Catania, Italia
| | - Michele Miraglia del Giudice
- Departamento de Mujeres, Niños y Cirugía Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
- * Ass. Prof. Dr. Michele Miraglia del Giudice,
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Parisi GF, Indolfi C, Decimo F, Leonardi S, Miraglia del Giudice M. COVID-19 Pneumonia in Children: From Etiology to Management. Front Pediatr 2020; 8:616622. [PMID: 33381482 PMCID: PMC7767924 DOI: 10.3389/fped.2020.616622] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is less serious in children than in adults. However, respiratory management dominates the clinical picture of hospitalized COVID-19 even in children. In some case series, deterioration of the clinical picture wherein dyspnea, cyanosis, and the onset of acute respiratory distress syndrome (ARDS) emerged ~8-10 days after the onset of SARS-CoV-2 infection, which could rapidly progress to multiple organ failure and death. This review aimed to evaluate the characteristics of COVID-19 pneumonia in pediatric populations, beginning from its etiology and pathological mechanisms and closing with its clinical management.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Rodriguez-Gonzalez M, Castellano-Martinez A, Cascales-Poyatos HM, Perez-Reviriego AA. Cardiovascular impact of COVID-19 with a focus on children: A systematic review. World J Clin Cases 2020; 8:5250-5283. [PMID: 33269260 PMCID: PMC7674714 DOI: 10.12998/wjcc.v8.i21.5250] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Since the beginning of the pandemic, coronavirus disease-2019 (COVID-19) in children has shown milder cases and a better prognosis than adults. Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults. AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency. METHODS Multiple searches in MEDLINE, PubMed were performed using the search terms "COVID-19" or "SARS-CoV-2" were used in combination with "myocardial injury" or "arrhythmia" or "cardiovascular involvement" or "heart disease" or "congenital heart disease" or "pulmonary hypertension" or "long QT" or "cardiomyopathies" or "channelopathies" or "Multisystem inflammatory system" or "PMIS" or "MIS-C" or "Pediatric multisystem inflammatory syndrome" or "myocarditis" or "thromboembolism to identify articles published in English language from January 1st, 2020 until July 31st, 2020. The websites of World Health Organization, Centers for Disease control and Prevention, and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts concerning the subject were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19 (PMIS), multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients. RESULTS A total of 193 articles were included. Most publications used in this review were single case reports, small case series, and observational small-sized studies or literature reviews. The meta-analysis of 16 studies with size > 10 patients and with complete data about cardiovascular involvement in children with PMIS showed that PMIS affects mostly previously healthy school-aged children and adolescents presenting with Kawasaki disease-like features and multiple organ failure with a focus on the heart, accounting for most cases of pediatric COVID-19 mortality. They frequently presented cardiogenic shock (53%), ECG alterations (27%), myocardial dysfunction (52%), and coronary artery dilation (15%). Most cases required PICU admission (75%) and inotropic support (57%), with the rare need for extracorporeal membrane oxygenation (4%). Almost all of these children wholly recovered in a few days, although rare deaths have been reported (2%). Out of PMIS cases we identified 10 articles reporting sporadic cases of myocarditis, pulmonary hypertension and cardiac arrythmias in previously healthy children. We also found another 10 studies reporting patients with pre-existing heart diseases. Most cases consisted in children with severe COVID-19 infection with full recovery after intensive care support, but cases of death were also identified. The management of different cardiac conditions are provided based on current guidelines and expert panel recommendations. CONCLUSION There is still scarce data about the role of cardiovascular involvement in COVID-19 in children. Based on our review, children (previously healthy or with pre-existing heart disease) with acute COVID-19 requiring hospital admission should undergo a cardiac workup and close cardiovascular monitoring to identify and treat timely life-threatening cardiac complications.
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Affiliation(s)
- Moises Rodriguez-Gonzalez
- Pediatric Cardiology Division, Puerta del Mar University Hospital, Cadiz 11009, Spain
- Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, Cadiz 11009, Spain
| | - Ana Castellano-Martinez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cadiz 11009, Spain
- Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, Cadiz 11009, Spain
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