Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Intensive Care Unit and Clinical Research, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Pediatr Res. 2020 Nov;88(5):705-716. doi: 10.1038/s41390-020-1053-9. Epub 2020 Jul 7.
Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU.
An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines.
This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described.
Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world.
At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.
受 COVID-19 大流行影响的儿童人数少于成年人，其临床表现也与成年人不同。一些儿童，特别是那些患有急性或慢性合并症的儿童，可能会发展为重症。最近，在一些患有这些疾病的儿童中描述了一种多系统炎症综合征（MIS-C），其中一些患者需要在儿科 ICU 接受治疗。
成立了一个国际合作组织，以审查现有证据并为患有 SARS-CoV-2 感染的重症儿童制定基于证据的护理指南。在缺乏证据的情况下，用基于共识的指南来填补这些空白。
这一过程产生了 44 项建议，涉及因呼吸窘迫或衰竭、脓毒症或感染性休克、心肺骤停、MIS-C 而就诊的儿科 COVID-19 患者，需要辅助治疗或 ECMO 的患者。还描述了解释儿童疾病较轻的模式以及使用已批准的抗病毒药物、抗炎或抗血栓治疗的潜力的证据。
简要总结了世界不同地区的儿科 SARS-CoV-2 感染情况，因为全球很少有登记处在捕获这些数据。这些指南旨在协调全球范围内 COVID-19 重症儿童接受重症监护的标准和策略。
在出版时，这是管理感染 SARS-CoV-2 的重症儿童的最新证据。参考这些指南可以降低受 COVID-19 及其后遗症影响的儿童的发病率，并有潜力降低死亡率。这些指南可以适用于高资源和低资源环境。
