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COVID-19 in neonates and children
COVID-19 paediatric multi-inflammatory syndrome
CHILDREN´S ANXIETY DURING GLOBAL PANDEMIC COVID-19
Introduction: The social distancing that has been imposed upon children caused massive upheaval to children’s lives. Aim: To analyze the children´s anxiety in the social distancing during a global pandemic. Method: Cross-sectional study using nonprobability sampling methods. Conducted in 2020 in the Botucatu Medical School, using an online survey. We included children in the social distancing between 6 and 12 years old. The instruments Children´s anxiety questionnaire (CAQ, score 4 to 12) and Numerical Rating Scale (NRS, scores 0-10) were used to measure anxiety. CAQ assesses the domains of happy/content; calm/relaxed; tense/nervous; afraid/worried, and answers range a lot, some, and a little. Results: We enrolled 157 girls and 132 boys, with a mean age of 8.84 (± 2.05). For happy, the rates of a lot, some, and a little were: 34.6, 51.6, and 13.8% respectively. For calm: 30.5, 51.2, and 18.3%. For tense: 56.5, 30.4, and 13.1%. And for afraid: 56.4, 30.4, and 13.1%. Median CAQ and NRS scores were 6.9 and 4.9. On univariate analysis, girls had a higher CAQ score than boys, but not for NRS. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents, more persons living together in home, and education level of parents or guardians. Conclusions: Despite low rates of children reporting worry and fear, the majority were not very happy and calm.
SEVERE AND FATAL CASES OF SARS-COV-2 INFECTIONS IN CHILDREN
Background and aims: The aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging ﬁndings, as well as the disease management and outcomes.
Methods: This retrospective, single-center, observational study was conducted in a french pediatric intensive and high-dependency care unit (PICU and HDU) between the beginning of the COVID-19 french epidemic till the end of the main epidemic spike. All patients, aged from 1 month to 18 years, admitted in PICU and HDU for conﬁrmed or highly suspected SARS-CoV-2 infection were included.
Results: Twenty-eight (28) children were included. Comorbidities were present in 18 patients (64%), mainly immuno-hemato-oncological (n = 8) and neurological (n = 5). COVID-19 diagnosis was primarily confirmed by nasopharyngeal and throat swabs (25 patients) or was highly suspected by chest CT-scan (3). The main reason for PICU and HDU admission was hypoxemic respiratory failure. Acute respiratory distress syndrome occurred in 8 patients (29%). Other complications were also frequent (associated infections and neurologic complications, respectively 29 and 11%). The mean duration of PICU and HDU stay was 5 days (1 – 45 days). Five children died, of whom three were without past medical history.
Conclusions: this report highlight some forms of SARS-Cov-2 infections in children. Healthcare personnel need to be aware that children may also have severe cases of this disease, although less common in adults.
EXPERIENCE DURING COVID-19 PANDEMIC IN A PAEDIATRIC INTENSIVE CARE UNIT
Background and aims
The COVID-19 pandemic has occasioned the collapse of the Spanish national health system. Two completely different clinical diseases: adults with acute respiratory distress syndrome (ARDS) and children with toxic shock syndrome (TSS). The objective is to describe their characteristics and outcomes.
Prospective observational study. Patients admitted to the Paediatric Intensive Care Unit from March to May 2020 with a positive COVID-19 have been included.
In total, 16 adults with ARDS were admitted. Median age 32years (IQR 23.3-41.5), 11 (68.8%) with relevant previous pathology: asthma (n=5;31%), obesity (n=7;43.7%), hypertension (n=2;12.5%). Of them, 13(81.2%) required mechanical ventilation (MV); median PEEP was 13(IQR 10.5-14.5), and median days under MV, 11(7.5-14). Ten (62.5%) required prone position and 5(31.3%) recruitment manoeuvres. Inotropic treatment needed in 6(37.5%), with a median inotropic score of 5(IQR 5-10). Afterwards, 1 patient had pulmonary thromboembolism.
Three previously healthy children presented a TSS. Median age 13 years (IQR 8-15). All needed inotropes due to the shock, with an inotropic score of 30(IQR 27.7-30). Two required MV (but with median PEEP of 6), and 1 non-invasive ventilation.
Differences were found in biomarkers, higher in children: MR-pro-adrenomedullin 1.7vs. 0.78nmol/L, p=0.012, procalcitonin 6.8 vs. 0.19 ng/mL, p=0.004, and C-reactive protein 333.9 vs. 146mg/L, p=0.008.
Adults and children seem to have different clinical presentations related to COVID-19. The adults presented severe ARDS, requiring mainly respiratory support while children presented toxic shock, needing haemodynamic support. Biomarkers are different depending on the disease; thus, they might be helpful.