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Severe pediatric COVID‑19:a review from the clinical and immunopathophysiological perspectives

World Journal of pediatrics 2024年第4期20卷 307-324页

作者： Yi‑Kan Sun Can Wang Pei‑Quan Lin Lei Hu Jing Ye Zhi‑Gang Gao Ru Lin Hao‑Min Li Qiang Shu Li‑Su Huang Lin‑Hua Tan Children's Hospital Zhejiang University School of MedicineHangzhou 310052China The Second Affiliated Hospital Zhejiang University School of MedicineHangzhou 310030China Surgical Intensive care Unit Children’s HospitalZhejiang University School of MedicineHangzhou 310052China Department of General Surgery Children’s HospitalZhejiang University School of MedicineHangzhou 310052China Department of Cardiopulmonary and Extracorporeal Life Support Children’s HospitalZhejiang University School of MedicineHangzhou 310052China Clinical Data Center Children’s HospitalZhejiang University School of MedicineHangzhou 310052China Department of Cardiac Surgery Children’s HospitalZhejiang University School of MedicineHangzhou 310052China National Clinical Research Center for Child Health Children’s HospitalZhejiang University School of MedicineHangzhou 310052China Department of Infectious Diseases Children’s HospitalZhejiang University School of MedicineHangzhou 310052China

Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in ***,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further attention from ***,the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely *** sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang *** keywords included“COVID-19 in children”,“severe pediatric COVID-19”,and“critical illness in children with COVID-19”.Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated *** respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be *** immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways,whose dysregulation in severe and critical diseases translates into adverse clinical *** inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric *** the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult *** Severe pediatric COVID-19 can affect multiple organ *** dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the

关键词： Immunopathophysiology MIS-C pediatric critical care Severe pediatric COVID-19

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pediatric interfacility transport effects on mortality and length of stay

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World Journal of pediatrics 2021年第4期17卷 400-408页

作者： Rod M.Shinozaki Andreas Schwingshackl Neeraj Srivastava Tristan Grogan Robert B.Kelly David Geffen School of Medicine at UCLA Los AngelesCAUSA University of California IrvineIrvineCAUSA Children’s Hospital of Orange County 1201 West La Veta AvenueOrangeCA92868USA

Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time,physician presence during transport,and mode of transport on mortality and length of stay(LOS)among pediatric *** hypothesized that a shorter response time and helicopter transports,but not physician presence,are associated with lower mortality and a shorter *** Retrospective,single-center,cohort study of 841 patients(pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport *** linear and logistic regression analyses adjusted for age,diagnosis,mode of transport,response time,stabilization time,return duration,mortality risk(pediatric index of mortality-2 and pediatric risk of mortality-3),and inotrope,vasopressor,or mechanical ventilation presence on *** Four hundred and twenty-eight(50.9%)patients were transported by helicopter,and 413(49.1%)were transported by *** accompanied 239(28.4%)*** median response time was 2.0(interquartile range 1.4–2.9)*** physician presence increased the median response time by 0.26 hours(P=0.020),neither physician presence nor response time significantly affected mortality,ICU length of stay(ILOS)or hospital length of stay(HLOS).Helicopter transports were not significantly associated with mortality or ILOS,but were associated with a longer HLOS(3.24 days,95%confidence interval 0.59–5.90)than ambulance transports(P=0.017).Conclusions These results suggest response time and physician presence do not significantly affect mortality or *** may reflect the quality of pre-transport care and medical control *** transports were only associated with a longer *** analysis provides a framework for examining transport workforce needs and associated costs.

关键词： Helicopter Hospital length of stay pediatric critical care pediatric intensive care unit Transport medicine

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