ABSTRACT
This paper studies the possible condition of fragility as a "dysfunctional psychophysical state" of the child in these times of SARS-CoV-2, based on neuroscientific studies, a biopsychological approach and on know-how from pediatric psychology. We bring to your attention a possible interventional approach for the support, orientation, accompaniment and shadowing of the child which has experienced and is still living through the pandemic, to allow the child to reverse the developmental risk that the COVID-19 pandemic constitutes. This period experienced by the child has taken on the meaning of a "developmental emergency", the importance of which depends on relations between disorders (caused by the state of fragility which exposure to the adverse event can determine) and the developmental resources available to the child. This "ferrying" must necessarily include the management of the child as a "field", bringing into play know-how from pediatric psychology. It is a "field" which is constituted by the outcome of relationships the child has with his/her reference system. For the professional figures involved, managing the field means intervening in all the types of relationships which define it. This is done through proximal, community-based interventions, promoting strengthening actions, such as reinforcing life skills, and, therefore, improving the developmental trajectory. This provides support to the child when facing transformation developmental tasks created by the developmental crisis which the pandemic, as a critical event, has determined.
ABSTRACT
Background: Despite the dominance of respiratory disease, acute-on-chronic liver failure (ACLF) and acute decompensation (AD) have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Moreover, COVID-19 has been associated with increased mortality in patients with end-stage liver disease (ESLD). Aim our study is to evaluate the impact of SARS-CoV-2 infection in patients with ESLD listed for liver transplant (LT). Methods: Data from adults listed for LT with laboratory-confirmed SARS-CoV-2 infection were collected from 7 LT centers across Italy. Results: From March 1st to October 31st 2020, 29 patients listed for LT were tested positive for SARS-CoV-2 infection. Twenty-one patients (72%) were male, median age was 59 years (20-71). The most common indication (70%) for LT was ESLD. The mean MELD score was 18 (8-32). At diagnosis, twenty patients (69%) presented at least one symptom: 38% fever, 28% dry cough, and 31% respiratory distress. Notably, 25% of patients presented hepatic encephalopathy as first presenting symptom. The remaining 9 patients (31%) were completely asymptomatic: nasopharyngeal swab was performed according to surveillance protocols. Twenty-one patients (70%) required hospitalization for the management of COVID-19. Respiratory support was necessary in 13 patients (45%): 5 (17%) required O2-supply, 4 (14%) non-invasive ventilation and 4 (14%) mechanical ventilation. Only five patients (17%) received at least one drug for infection treatment (see table). Heparin was administrated in 7 patients (28%). No bleeding episodes were reported. Eight (%) patients died after a median time of 6 days (2-29) from Covid-19 diagnosis, with a 30-day-mortality rate of 30%. Three patients died of liver failure, while the remaining of multiple organ failures. In the univariate analysis, factors associated with 30-days mortality were respectively presence of comorbidities (0.07), severity of liver disease according to MELD score (0.05) and severity of respiratory failure (0.011). In the cox-regression analysis, only the severity of respiratory failure was significantly associated with the mortality (HR 3.13, IC 1.53-6.3). Conclusions: COVID-19 is associated with elevated mortality in LT candidates, listed for ESLD.