Adeyinka Adebayo, Bailey Keneisha, Pierre Louisdon, Kondamudi Noah
Department of Pediatrics The Brooklyn Hospital Center New York New York USA.
J Am Coll Emerg Physicians Open. 2021 Jan 29;2(1):e12375. doi: 10.1002/emp2.12375. eCollection 2021 Feb.
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, causing innumerable deaths and a massive economic catastrophe. Exposure to household members with confirmed COVID-19 is the most common source of infection among children. Children are just as likely as adults to get infected with SARS-CoV-2. Most children are asymptomatic and when symptoms occur, they are usually mild. Infants <12 months old are at a higher risk for severe or critical disease. COVID-19 is diagnosed the same way in pediatric population as adults by testing specimen obtained from upper respiratory tract for nucleic acid amplification test (NAAT) using reverse transcriptase viral polymerase chain reaction (RT-PCR). The common laboratory findings in hospitalized patient include leukopenia, lymphopenia, and increased levels of inflammatory markers. Chest X-ray findings are variable and computed tomography scans of the chest may show ground glass opacities similar to adults or non-specific findings. Prevention is the primary intervention strategy. Recently the U.S. Food and Drug Administration (FDA) has provided emergency authorization of the Pfizer-BioNTech COVID-19 vaccine and many other vaccine candidates are in the investigational stage. There is limited data in children on the use of antivirals, hydroxychloroquine, azithromycin, monoclonal antibody, and convalescent plasma. Oxygen therapy is required in hypoxic children (saturation <92%). Similar to adults, other measures to maintain oxygenation such as high flow nasal cannula, CPAP, or ventilatory support may be needed. Ventilatory management strategies should include use of low tidal volumes (5-6 cc/kg), high positive expiratory pressure, adequate sedation, paralysis, and prone positioning. Recently, a new entity associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C) has emerged. Clinical, laboratory, and epidemiological criteria are the basis for this diagnosis. Management options include ICU admission, steroids, intravenous gamma globulin, aspirin, anakinra, and anticoagulants. Vasoactive-inotropic score (VIS) is used to guide vasopressor support.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）大流行已在全球迅速蔓延，导致无数人死亡和巨大的经济灾难。接触确诊感染COVID-19的家庭成员是儿童中最常见的感染源。儿童感染SARS-CoV-2的可能性与成人相同。大多数儿童无症状，出现症状时通常较轻微。12个月以下的婴儿患重症或危重症的风险更高。在儿科人群中，COVID-19的诊断方式与成人相同，即通过使用逆转录病毒聚合酶链反应（RT-PCR）对从呼吸道上获取的标本进行核酸扩增检测（NAAT）。住院患者的常见实验室检查结果包括白细胞减少、淋巴细胞减少以及炎症标志物水平升高。胸部X线检查结果各不相同，胸部计算机断层扫描可能显示与成人相似的磨玻璃影或非特异性表现。预防是主要的干预策略。最近，美国食品药品监督管理局（FDA）已授予辉瑞-生物科技公司COVID-19疫苗紧急使用授权，许多其他候选疫苗正处于研究阶段。关于儿童使用抗病毒药物、羟氯喹、阿奇霉素、单克隆抗体和康复期血浆的数据有限。缺氧儿童（血氧饱和度<92%）需要吸氧治疗。与成人一样，可能需要采取其他维持氧合的措施，如高流量鼻导管吸氧、持续气道正压通气（CPAP）或通气支持。通气管理策略应包括使用低潮气量（5-6毫升/千克）、高呼气末正压、充分镇静、肌松以及俯卧位通气。最近，一种与COVID-19相关的新病症——儿童多系统炎症综合征（MIS-C）出现了。临床、实验室和流行病学标准是该诊断的依据。治疗选择包括入住重症监护病房、使用类固醇、静脉注射丙种球蛋白、阿司匹林、阿那白滞素和抗凝剂。血管活性药物-正性肌力药物评分（VIS）用于指导血管活性药物支持治疗。
