ABSTRACT
The impact of the COVID-19 pandemic has been overlooked in children and adolescents since many of the negative effects have been the result of containment and mitigation measures and will only be quantifiable in the medium and long term. Although the global response has been successful in reducing the lethality of the disease, the harmful effect on vulnerable populations, such as children and adolescents, is enormous and has been classified as catastrophic by international organizations. The pandemic has deeply affected the physical and mental health of children and adolescents, but also silently its negative effects extend across many areas such as schooling, familiar economy, child labor and food security. The third year of the pandemic is an opportunity to include the multidimen sional well-being of children and adolescents as a cornerstone of society's response to a global crisis, whether health, economic or political.
Subject(s)
COVID-19 , Adolescent , COVID-19/epidemiology , Child , Humans , Mental Health , PandemicsSubject(s)
COVID-19/complications , Encephalomyelitis, Acute Disseminated/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Encephalomyelitis, Acute Disseminated/therapy , Encephalomyelitis, Acute Disseminated/virology , Female , Humans , Infant , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapySubject(s)
Bronchodilator Agents/therapeutic use , COVID-19/therapy , Hypoxia/therapy , Nitric Oxide/therapeutic use , Patient Positioning/methods , Prone Position , Administration, Inhalation , COVID-19/physiopathology , Combined Modality Therapy , Humans , Hypoxia/virology , Infant , Severity of Illness IndexABSTRACT
BACKGROUND: The COVID-19 pandemic reached the Southern Hemisphere in the autumn of 2020, thus coinciding with its expected annual viral respiratory season. The potential impact of national strategies aimed at mitigating COVID-19 during the pandemic on the incidence of other critical viral lower respiratory tract infections (LRTIs) in children is unknown. METHODS: We analysed admission data for LRTIs from 22 paediatric intensive care units (PICUs) in four countries, part of a large international Latin American registry of children with acute respiratory failure (Red Colaborativa Pediátrica de Latinoamérica [LARed Network]). RESULTS: Between January and August, there were 83% fewer PICU admissions for LRTIs in 2020 compared to the 2018/2019 average over the same period. Similar decreases were noted for PICU admissions due to respiratory syncytial virus and influenza (92% and 78%, respectively). CONCLUSION: We observed a striking reduction in PICU admissions due to viral LRTIs over winter, during the COVID-19 pandemic in South America.
ABSTRACT
Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.
El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de procesos.
Subject(s)
COVID-19/therapy , Practice Guidelines as Topic , Systemic Inflammatory Response Syndrome/therapy , Adolescent , COVID-19/physiopathology , Child , Humans , Referral and Consultation , Shock, Septic/physiopathology , Shock, Septic/therapy , Systemic Inflammatory Response Syndrome/physiopathologySubject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Global Health , Intensive Care Units, Pediatric/organization & administration , Pandemics/statistics & numerical data , Pneumonia, Viral/therapy , Severe Acute Respiratory Syndrome/therapy , Adolescent , COVID-19 , Child , Child, Preschool , Chile , Cohort Studies , Colombia , Combined Modality Therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Critical Illness/mortality , Critical Illness/therapy , Drug Therapy, Combination , Female , Hospital Mortality , Humans , Internationality , Italy , Male , Pediatrics/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Respiration, Artificial/methods , Retrospective Studies , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/mortality , Spain , United StatesABSTRACT
Critical care management of patients with COVID-19 has been influenced by a mixture of public, media and societal pressure, as well as clinical and anecdotal observations from many prominent researchers and key opinion leaders. These factors may have affected the principles of evidence-based medicine and encouraged the widespread use of non-tested pharmacological and aggressive respiratory support therapies, even in intensive care units (ICUs). The COVID-19 pandemic has predominantly affected adult populations, while children appear to be relatively spared of severe disease. Notwithstanding, paediatric intensive care (PICU) clinicians may already have been influenced by changes in practices of adult ICUs, and these changes may pose unintended consequences to the vulnerable population in the PICU. In this article, we analyse several potential iatrogenic causes of the detrimental effects of the current pandemic to children and highlight the risks underlying a sudden change of clinical practice.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Illness/therapy , Evidence-Based Medicine , Iatrogenic Disease/prevention & control , Pneumonia, Viral/therapy , COVID-19 , Child , Coronavirus Infections/epidemiology , Critical Care , Humans , Intensive Care Units, Pediatric , Medical Errors , Pandemics , Pediatrics , Pneumonia, Viral/epidemiology , SARS-CoV-2ABSTRACT
Abstract: The appearance of SARS-CoV-2 from December 2019 and its rapid expansion in the world reaching Pandemic status, has become a great challenge for health teams. Although the evidence of infection in children is still scarce compared to that of adults, it has become evident that at the pediatric po pulation level, most of the time the infection is asymptomatic or mild, but not all the patients have this evolution, which has motivated the discussion in the Pediatric Critical Care teams regarding how to face these patients with a more serious disease. This consensus is the result of the work of the Pediatric Intensive Care Branch of the Chilean Society of Pediatrics, collecting the evidence available at the time of the review plus the opinion of national experts in Pediatric Intensive Care. The purpose of these recommendations is to offer teams that care for critically ill pediatric patients a guide for the diagnosis and treatment of patients who evolve with severe COVID 19, which can be applied in all Pediatric UPCs in our country, with special emphasis in those measures that have shown greater effectiveness at the level of diagnostic studies, treatment and care of health personnel.