İSTANBUL’DA ÜÇÜNCÜ BASAMAK BİR MERKEZİN COVID-19 PANDEMİSİNDE ÇOCUKLARDAKİ DENEYİMİ

Yıl 2021, Cilt: 84 Sayı: 3, 293 - 300, 31.07.2021

Özge Kaba , Mehpare Sarı Yanartaş , Selda Hançerli Törün , Kamala Alakbarova Zuhal Bayramoğlu , Mustafa Önel , Sevim Meşe , Ali Ağaçfidan , Ayper Somer

https://doi.org/10.26650/IUITFD.2021.806433

Öz

Amaç: Beklenmedik bir anda tüm dünyayı etkileyen SARS-CoV-2 virüsü milyonlarca insanı enfekte etmeye ve yüzbinlerce insanın da ölüme neden olmaya devam etmektedir. Pediyatrik yaş grubuna dair görüş birliği henüz sağlanamamıştır. Bu nedenle merkezimize ait pediyatrik grup deneyiminin paylaşılması amaçlanmıştır. Gereç ve Yöntem: Pandemi ilanından sonra merkezimize COVID-19 hastalığı şüphesiyle başvuran 1076 çocuk olgu ele alındı. SARS-CoV-2 polimeraz zincir reaksiyon testinde pozitif olan 85 çocuk, epidemiyolojik, klinik, laboratuvar ve görüntüleme verileri ile retrospektif olarak değerlendirildi. Bulgular: Hastaların yarısı erkek ve yaklaşık yarısı 60-179 ay arasındaydı. Hastaların %80’inde ev içi temas/maruziyet mevcuttu. En sık şikayetler sırasıyla %51,8 ve %47,1 oranlarıyla öksürük ve ateşti. Hastaların %72,9’unda daha hafif klinik tablo ve sadece %2,4’ünde kritik hastalık vardı. En çarpıcı laboratuvar bulgusu lenfopeniydi. Görüntüleme sonuçları, anormal toraks BT oranının %10,6 olduğunu gösterdi. Hastaların %80’ine evde izolasyon uygulandı. Hastanede yatan hastaların sadece %4,7’sinde çeşitli spesifik tedaviler uygulandı. Hidroksiklorokin, intravenöz immünglobulin ve tosilizumab alan bu hastalardan biri öldü. Mortalite oranı %1,5 idi. Sonuç: Güvenilir tanısal testlerin ve çocuklar için uygun spesifik antiviral tedavilerin yokluğunda, COVID-19 enfeksiyonunu daha iyi anlamak ve yönetmek için daha virolojik, epidemiyolojik, klinik, laboratuvar ve görüntüleme çalışmalarına ihtiyaç olduğu fikrine varıldı.

Anahtar Kelimeler

COVID-19, çocuk, yönetim, tedavi

EXPERIENCE IN CHILDREN IN THE COVID-19 PANDEMIC OF A TERTIARY CENTER, IN ISTANBUL

Öz

Objective: The SARS-CoV-2 virus, which unexpectedly has affected the whole world, continues to infect millions of people and causes the death of hundreds of thousands of people. There has been no consensus on the pediatric age group yet. For this reason, it was aimed to share the pediatric group experience of our center. Material and Method: After the pandemic announcement, 1076 pediatric cases admitted to our center with suspected COVID-19 disease were discussed. Eighty-five children who were positive in the SARS-CoV-2 polymerase chain reaction test, were evaluated retrospectively with epidemiological, clinical, laboratory and imaging data. Results: Half of the patients were male and about half of them were between 60-179 months. The household contact/exposure was 80% of the patients. The most common complaints were cough and fever, with the rates of 51.8% and 47.1%, respectively. There was a milder clinic 72.9% of patients and critical illness only 2.4% of the patients. The most striking laboratory finding was lymphopenia. Imaging results showed that abnormal thorax CT rate was 10.6%. Isolation at home was administered on 80% of the patients. Various specific treatments were used only in 4.7% of the hospitalized patients. One of these patients who received hydroxychloroquine, intravenous immunglobuline and tocilizumab died. The mortality rate was 1.5%. Conclusion: In the absence of reliable diagnostic tests and specific antiviral treatments appropriate for children, it was concluded that we need more virological, epidemiological, clinical, laboratory and imaging studies to better understand and manage COVID-19 infection.

Anahtar Kelimeler

COVID-19, child, management, treatment

Kaynakça

• 1. World Health Organization (WHO). Emergencies. Diseases. Coronavirus disease (COVID-19). Situation reports. Situation report-51. Available at https://www.who.int/docs/defaultsource/ coronaviruse/situation-reports/20200311-sitrep-51- covid-19.pdf?sfvrsn=1ba62e57_10 Accessed on 5 Oct, 2020
• 2. World Health Organization (WHO). Emergencies. Diseases. Coronavirus disease 2019. Available at https://www.who.int/ emergencies/diseases/novel-coronavirus-2019. Accessed on 5 Oct, 2020.
• 3. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez- Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera- Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623. [CrossRef]
• 4. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109(6):1088-1095. [CrossRef]
• 5. Halk Sağlığı Genel Müdürlüğü, COVID-19 Bilgilendirme Sayfası, COVID-19 Rehberi Çocuk Hasta Yönetimi ve Tedavi. Available at https://covid19.saglik.gov.tr/Eklenti/38596/0/ covid-19rehbericocukhastayonetimivetedavipdf.pdf Accessed on 5 Oct, 2020.
• 6. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020;145(6):e20200702. [CrossRef]
• 7. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARSCoV-2 infection in children 2020. N Engl J Med 2020;382(17):1663- 5. [CrossRef]
• 8. Tezer H, Bedir Demirdağ T. Novel coronavirus disease (COVID-19) in children. Turk J Med Sci 2020;50(SI-1):592- 603. Published 2020 Apr 21. [CrossRef]
• 9. Parri N, Lenge M, Buonsenso D; Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med 2020;383(2):187-90. [CrossRef]
• 10. Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr 2020 Apr 8:e201346. [CrossRef]
• 11. Centers for Disease Control and Prevention, Coronavirus Disease (COVID-19), Cases&Data, MMWR COVID-19 Reports, Changing Age Distribution of the COVID-19 Pandemic—United States, May–August 2020. Available at https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm69 39e1-H.pdf. Accessed on 5 Oct, 2020.
• 12. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239-42. [CrossRef]
• 13. Chowell G, Abdirizak F, Lee S, Lee J, Jung E, Nishiura H, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med 2015;13:210. [CrossRef]
• 14. Zhang B, Liu S, Zhang J, Xiao J, Zhu S, Dong Y, et al. Children hospitalized for coronavirus disease 2019 (COVID-19): A multicenter retrospective descriptive study. J Infect 2020;81(2):e74-5. [CrossRef]
• 15. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62. [CrossRef]
• 16. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69(13):382-386. [CrossRef]
• 17. Deza Leon MP, Redzepi A, McGrath E, Abdel-Haq N, Shawaqfeh A, Sethuraman U, et al. COVID-19 Associated Pediatric Multi-System Inflammatory Syndrome. J Pediatric Infect Dis Soc 2020;9(3):407-8. [CrossRef]
• 18. Chang TH, Wu JL, Chang LY. Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis. J Formos Med Assoc 2020;119(5):982-9. [CrossRef]
• 19. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-1720. [CrossRef]
• 20. Ma H, Hu J, Tian J, Zhou X, Li H, Laws MT, et al. A singlecenter, retrospective study of COVID-19 features in children: a descriptive investigation. BMC Med 2020;18(1):123. Published 2020 May 6. [CrossRef]
• 21. Steinberger S, Lin B, Bernheim A, Chung M, Gao Y, Xie Z, et al. CT Features of Coronavirus Disease (COVID-19) in 30 Pediatric Patients. AJR Am J Roentgenol 2020;215(6):1303- 11. [CrossRef]
• 22. Chen A, Huang J, Liao Y, Liu Z, Chen D, Yang C, et al. Differences in clinical and imaging presentation of pediatric patients witf COVID-19 in comparison with adults. Radiol Cardiothrac Imaging 2020;2(2):e200117. [CrossRef]
• 23. Chen ZM, Fu JF, Shu Q, Chen YH, Hua CZ, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr 2020;16(3):240-6. [CrossRef]
• 24. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr 2020;174(9):868-73. [CrossRef]
• 25. Chiotos K, Hayes M, Kimberlin DW, Jones SB, James SH, Pinninti SG, et al. Multicenter initial guidance on use of antivirals for children with coronavirus disease 2019/severe acute respiratory syndrome coronavirus 2. J Pediatric Infect Dis Soc 2020;9(6):701-15. [CrossRef]