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Pediatrik COVID-19 Vakalarının Klinik Değerlendirilmesi: 3. Basamak Tek Merkez Deneyimi

Yıl 2022, Cilt: 44 Sayı: 5, 613 - 619, 29.09.2022
https://doi.org/10.20515/otd.1015712

Öz

Pandeminin başlangıcından itibaren çocuklarda COVID-19 tanı, klinik bulguları ve yönetimi hakkında sınırlı sayıda çalışma yayınlanmıştır. Bu çalışma ile çocuk hastalarda COVID-19 enfeksiyonun klinik ve epidemiyolojik özelliklerini ve deneyimlerimizi paylaşmayı amaçladık. Mart 2020 -Aralık 2020 tarihleri arasında hastanemizde takip ettiğimiz COVID-19 polimeraz zincir reaksiyon testi pozitif çocuk hastalar çalışmaya dahil edildi. Hastaların epidemiyolojik, laboratuvar, radyolojik ve klinik verileri geriye dönük olarak incelendi. Çalışmaya 246 çocuk hasta kabul edildi. Hastaların, %53'ü kızdı ve ortanca yaşı 9’du (2 ay-17 yıl) ve 76’sı (%31) asemptomatikti. En sık semptomlar, öksürük (%48), ateş (%43) ve boğaz ağrısıydı (%15). Olguların 199'unun (%81) ailesinde temas öyküsü mevcuttu ve 32'sinin (%12) kronik hastalığı vardı. En sık görülen laboratuvar bulguları; lenfopeni (%26), eozinopeni (%21), monositoz (%18), yüksek C-reaktif protein (%20) di. Vakaların %32’si asemptomatik, % 52’si hafif, %14’ü orta, %1,2’si şiddetli (%1.2), %0,4’ü kritik sınıftaydı. Hastaların 48'i (%19,5) hastaneye yatırıldı, 11'i (%4,5) yoğun bakımda takip edildi. Hastaların 25’ine (%10) akciğer tomografisi çekildi ve 10’unda (%4) anaormal bulgular mevcuttu. Tedavi olarak 22 (%8) hastaya favipiravir, 1 (%0,4) lopinavir-ritonavir, 16 (%6) antibiyotik, 4 (%1,6) steroid ve %3 (1,2) düşük molekül ağırlıklı heparin verildi. COVID-19, çocuklarda sıklıkla asemptomatik ve hafif olmasına rağmen, nadiren şiddetli seyredebilir. Özellikle bir yaşın altındaki çocuklarda ve komorbiditesi olan hastalarda daha dikkatli olunmalıdır.

Destekleyen Kurum

Ek kurum desteği yok

Proje Numarası

Proje yok

Teşekkür

Katkılarından dolayı, çocuk yoğun bakım ve çocuk acil servise teşekkür ederiz

Kaynakça

  • 1. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. New Engl J Med 2020;382:1199-207.
  • 2. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report – 73.Geneva,Switzerland:WorldHealthOrganization;2020.
  • 3. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel Coronavirus: implications for virus origins and receptor binding. Lancet. 2020.
  • 4. Chan JF, Yuan S, Kok KH et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15;395(10223):514-23.
  • 5. Fang F, Luo XP. Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives. Zhonghua Er Ke Za Zhi. 2020;58(2):81-85.
  • 6. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020. Epub March 16, 2020.
  • 7. CDC COVID-19 Response Team. Coronavirus disease 2019 in children-United States, February 12-April 2, 2020. MMWR 2020;69:422-6.
  • 8. Xie X, Chen J, Wang X, et al. Age- and gender-related difference of ACE2 expression in rat lung. Life Sci 2006; 78: 2166–71.
  • 9. Lee PI, Hu YL, Chen PY, et al. Are children less susceptible to COVID-19? J Microbiol Immunol Infect 2020; 53: 371–2.
  • 10. Ludvigsson JF. A systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020.
  • 11. 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 May
  • 12. Robbins E, Ilahi Z, Roth P. Febrile Infant: COVID-19 in Addition to the Usual Suspects. Pediatr Infect Dis J 2020; 39.
  • 13. Zheng F, Liao C, Fan QH, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci 2020; 40: 275–80.
  • 14. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.
  • 15. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020 Apr 10.
  • 16. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020; 58: 1135-8.
  • 17. Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol 2020; 55: 1169–74.
  • 18. 18 Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Feb 26:200642.
  • 19. Yang P, Liu P, Li D, et al. Corona Virus Disease 2019, a growing threat to children?. J Infect 2020; 80: P671–93. 35.
  • 20. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 enfeksiyonu) COVID-19_Rehberi-6-12.04.2020.
  • 21. Chen C, Huang J, Cheng Z, et al. Favipiravir versus arbidol for COVID-19: a randomized clinical trial. MedRxiv. 2020 April 15. doi: https://doi.org/10.1101/2020.03.17.2003 7432.
  • 22. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382: 1787–99.
  • 23. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet 2020; 395: 473–5.
  • 24. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2020.
  • 25. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033–4.
  • 26. Shen C, Wang Z, Zhao F, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA 2020; 323: 1582–9.

Clinical manifestations of COVID-19 in children at a pediatric tertiary center in Turkey

Yıl 2022, Cilt: 44 Sayı: 5, 613 - 619, 29.09.2022
https://doi.org/10.20515/otd.1015712

Öz

Limited studies have been published on practices and management of coronavirus disease-2019 (COVID-19) in children from the beginning of the pandemic. With this study, we aimed to share the clinical and epidemiological characteristics of infection in pediatric patients and our experiences. COVID-19 Polymerase Chain Reaction (PCR) test positive pediatric patients we followed up in our hospital between March to December 2020 were included in the study. The epidemiological, laboratory, radiological, and clinical data of the patients were analyzed retrospectively. During the study period, 246 test positive pediatric patients were admitted. The median age was 9 years (2 months-17 years), girls accounted for 53,7%, and 76 (31%) patients were asymptomatic. The cough was the predominant symptom (48%), followed by fever (43%) and sore throat (15%). There was a household contact in 199 (81%) of all cases and 32 (12%) patients had comorbidity and chronic illness. The most common laboratory findings; lymphopenia (26%), eosinopenia (21%), monocytosis (18%), high C-reactive protein (20%). Distribution according to case classes; asymptomatic (32,2%), mild (52,4%), moderate (13,8%), severe (1.2%), critical (0.4%). Of all cases, 48 (19.5%) were inpatients and 11 (4.5%) were in intensive care. Chest tomography was performed in 25 (10%) patients and 10 (4%) were abnormal. As a treatment, 22 (8%) patients received favipiravir, 1 (0.4%) lopinavir-ritonavir, 16 (%6) antibiotics, 4 (1.6%) methylprednisolone and 3 (1.2%) low molecular weight heparin. COVID-19 is often asymptomatic and mild in children, it may rarely have a severe course. More caution should be exercised in children under 1 year of age and patients with comorbidities.

Proje Numarası

Proje yok

Kaynakça

  • 1. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. New Engl J Med 2020;382:1199-207.
  • 2. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report – 73.Geneva,Switzerland:WorldHealthOrganization;2020.
  • 3. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel Coronavirus: implications for virus origins and receptor binding. Lancet. 2020.
  • 4. Chan JF, Yuan S, Kok KH et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15;395(10223):514-23.
  • 5. Fang F, Luo XP. Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives. Zhonghua Er Ke Za Zhi. 2020;58(2):81-85.
  • 6. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020. Epub March 16, 2020.
  • 7. CDC COVID-19 Response Team. Coronavirus disease 2019 in children-United States, February 12-April 2, 2020. MMWR 2020;69:422-6.
  • 8. Xie X, Chen J, Wang X, et al. Age- and gender-related difference of ACE2 expression in rat lung. Life Sci 2006; 78: 2166–71.
  • 9. Lee PI, Hu YL, Chen PY, et al. Are children less susceptible to COVID-19? J Microbiol Immunol Infect 2020; 53: 371–2.
  • 10. Ludvigsson JF. A systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020.
  • 11. 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 May
  • 12. Robbins E, Ilahi Z, Roth P. Febrile Infant: COVID-19 in Addition to the Usual Suspects. Pediatr Infect Dis J 2020; 39.
  • 13. Zheng F, Liao C, Fan QH, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci 2020; 40: 275–80.
  • 14. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13.
  • 15. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020 Apr 10.
  • 16. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clin Chem Lab Med 2020; 58: 1135-8.
  • 17. Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol 2020; 55: 1169–74.
  • 18. 18 Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Feb 26:200642.
  • 19. Yang P, Liu P, Li D, et al. Corona Virus Disease 2019, a growing threat to children?. J Infect 2020; 80: P671–93. 35.
  • 20. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 enfeksiyonu) COVID-19_Rehberi-6-12.04.2020.
  • 21. Chen C, Huang J, Cheng Z, et al. Favipiravir versus arbidol for COVID-19: a randomized clinical trial. MedRxiv. 2020 April 15. doi: https://doi.org/10.1101/2020.03.17.2003 7432.
  • 22. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020; 382: 1787–99.
  • 23. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet 2020; 395: 473–5.
  • 24. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2020.
  • 25. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033–4.
  • 26. Shen C, Wang Z, Zhao F, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA 2020; 323: 1582–9.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Yalçın Kara 0000-0003-0569-1106

Mahmut Can Kızıl Bu kişi benim 0000-0002-6231-4238

Ebru Kaçmaz 0000-0002-7136-9441

Mehmet Özgür Arslanoğlu 0000-0003-3798-0260

Eylem Kıral 0000-0003-2245-5340

Gürkan Bozan 0000-0001-5041-8892

Ömer Kılıç 0000-0003-0168-4080

Sabiha Sahin 0000-0003-0759-4158

Tercan Us 0000-0002-9772-6777

Gül Durmaz 0000-0002-2002-8380

Ener Dınleyıcı, Md 0000-0002-0339-0134

Proje Numarası Proje yok
Yayımlanma Tarihi 29 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 44 Sayı: 5

Kaynak Göster

Vancouver Kara Y, Kızıl MC, Kaçmaz E, Arslanoğlu MÖ, Kıral E, Bozan G, Kılıç Ö, Sahin S, Us T, Durmaz G, Dınleyıcı, Md E. Clinical manifestations of COVID-19 in children at a pediatric tertiary center in Turkey. Osmangazi Tıp Dergisi. 2022;44(5):613-9.


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