Critically Ill Pediatric Patient and SARS-CoV-2 Infection
Abstract
:1. Introduction
2. SARS-CoV-2 Basic Information
3. COVID-19 Clinical Presentation and Risk Factors
4. Pediatric Population
5. Diagnostic Methods and Laboratory and Imaging Findings
6. Initial Approach
6.1. Airway and Breathing (A+B)
6.2. Circulation (C)
6.3. Disability (D)
6.4. Exposure/Examination
7. Antiviral Treatment and Immunotherapy
7.1. Remdesivir
7.2. Dexamethasone
7.3. Tocilizumab
8. Supportive Intensive Care
9. PIMS-TS/MIS-C
9.1. Definition
9.2. Clinical Presentation
9.3. Initial Approach
9.4. Specific Treatment
9.5. Outcome
10. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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WHO Label | Pango Lineage | Earliest Documented Samples | Date of Designation |
---|---|---|---|
Alpha | B.1.1.7 | United Kingdom, September 2020 | 18 December 2020 |
Beta | B.1.351 | South Africa, May 2020 | 18 December 2020 |
Gamma | P.1 | Brazil, November 2020 | 11 January 2021 |
Delta | B.1.617.2 | India, October 2020 | VOC: 11 May 2021 |
Omicron | B.1.1.529 | Multiple countries, November 2021 | VOC: 26 November 2021 |
Asymptomatic infection | No clinical or radiological signs of COVID-19, positive PCR or antigen test |
Mild infection | Upper respiratory tract infection symptoms—fever; flu-like symptoms—myalgia, joint pain, fever, cough, sneezing, running nose, abdominal discomfort/pain, anosmia, ageusia, no radiological signs of disease |
Moderate infection | Upper and lower respiratory tract infection signs with possible wheezing, crackles, dyspnea with oxygen saturation < 94% on air, radiological signs of disease (X-ray or computed tomography) without other vital signs of deterioration |
Severe infection | Dyspnea, tachypnea, hypoxemia (oxygen saturation < 94% on air) + radiological findings (in over 50% of lung tissue) |
Critical infection | ARDS, encephalopathy, coagulopathy, acute renal failure, heart failure, shock, multiorgan failure + radiological findings |
ABCDE Initial Approach by ERC and EPALS * | ||
---|---|---|
ABCDE Approach | Aim | Action/Management |
A—Airway | Airway patency, cervical spine protection if indicated | Open the mouth, bend the head (over 1 year), use airway if needed, MILS **, cervical collar or head blocks |
B—Breathing | Spontaneous breathing efficacy, normoxemia, normocapnia | Pulse oximetry, oxygen, mechanical ventilation if indicated, capnography and blood gases analysis |
C—Circulation | Oxygen delivery to meet the demand, blood pressure (50–95% according to age), adequate heart rate, capillary refill time ≤ 2 s, lactate ≤ 2 mmol/L | Fluid resuscitation (10 mL/kg fluid challenge), vasopressors or antihypertensives to meet target blood pressure |
D—Disability | GCS ≥ 9, seizures control | Tracheal intubation and mechanical ventilation if GCS ≤ 8 and anticonvulsants |
E—Exposure/Examination | Clinical examination, temperature management, normoglycemia (6–10 mmol/L) | Insulin or glucose to meet target glycemia, normothermia |
Organization | Centers for Disease Control and Prevention USA definition | Royal College of Pediatrics and Child Health definition AND European Centre for Disease Control and Prevention definition | World Health Organization |
Country | United States of America | United Kingdom and Europe | Worldwide |
Syndrom/disease name | Multisystemic inflammatory syndrome in children (MIS-C) | Pediatric inflammatory multisystemic syndrome temporally associated with COVID-19 (PIMS-TS) | Multisystemic inflammatory syndrome in children (MIS-C) |
Age | <21 years | All children (age not defined) | 0–19 years |
Clinical symptoms | Both of the following:
| Both of the following:
| At least 2 of the following:
|
Inflammation | Laboratory evidence of inflammation including, but not limited to, 1 or more of the following:
| All 3 of the following:
| Elevated inflammation markers, including any of the following:
|
Link to SARS–CoV-2 | Current or recent findings of the following:
| Positive or negative by PCR | Evidence of COVID-19 by the following:
|
Exclusion | No alternative diagnosis | Other infections | No obvious microbial cause |
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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, 538. https://doi.org/10.3390/children9040538
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(4):538. https://doi.org/10.3390/children9040538
Chicago/Turabian StyleKlučka, Jozef, Eva Klabusayová, Milan Kratochvíl, Tereza Musilová, Václav Vafek, Tamara Skříšovská, Martina Kosinová, Pavla Havránková, and Petr Štourač. 2022. "Critically Ill Pediatric Patient and SARS-CoV-2 Infection" Children 9, no. 4: 538. https://doi.org/10.3390/children9040538
APA StyleKlučka, J., Klabusayová, E., Kratochvíl, M., Musilová, T., Vafek, V., Skříšovská, T., Kosinová, M., Havránková, P., & Štourač, P. (2022). Critically Ill Pediatric Patient and SARS-CoV-2 Infection. Children, 9(4), 538. https://doi.org/10.3390/children9040538