Jun 30, 2020
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American doctors updated recommendations for the diagnosis and treatment of COVID-19 in children

The document includes the results of relevant studies on the diagnosis and treatment of coronavirus in children, as well as detailed recommendations on the treatment and prevention of infection.

Children are still not at risk

The recommendations were made by Professor of Clinical Infectious Diseases, University of California, Jaime G Deville. In the first part of the document, the author recalled that children of all ages can get coronavirus, but this does not happen as often as in adults - on average from 1 to 5%.

As of April 2, 2020, of the 149,760 confirmed cases reported by the Centers for Disease Control and Prevention (CDC), only 1.7% were in children under the age of 18. About 90% of cases were related to home or social contacts, and 10% were related to travel, the document says.

It is still unknown whether SARS-CoV-2 can be transmitted through breastfeeding, the only test report did not identify the virus in the breast milk of six patients. However, a drip route of transmission is possible during close contact between mother and baby during feeding.

Fever and cough are the most common symptoms in children, writes Professor Deville. Of the 291 cases of childhood illness, 56% had a high fever, 54% had a cough, and 13% had shortness of breath, and 73% of the children had at least one of these symptoms. Less common symptoms include fatigue, rhinorrhea, nasal congestion, diarrhea, and vomiting.

The author notes that despite reports of severe cases of COVID-19 in children, including fatal cases, it is most likely that most small patients are asymptomatic, either in mild or moderate forms. Infants under 1 year old and children with chronic lung diseases (including asthma), cardiovascular diseases, as well as patients with immunosuppression associated, for example, with chemotherapy, are at greater risk of a severe course of the disease. Chronic diseases of the kidneys, liver, endocrine disorders, and severe obesity can create a risk of a severe course of the disease.

The recommendation separately emphasizes that it is still unclear why COVID-19 is less common and does not have such a severe course in children compared with adults. Perhaps the children's body gives a less aggressive immune response that causes a cytokine storm. Another explanation is that the interaction of viruses in the respiratory tract of young children leads to a decrease in their viral load. The version that the coronavirus receptor ACE-2 can be expressed in the airways in children is not the same as in adults.

A New Threat - Children's Multisystem Inflammatory Syndrome

A separate block of recommendations is devoted to childhood multisystemic inflammatory syndrome (DMVS) - a rare but serious condition that can be caused by COVID-19. In Europe and the United States recorded dozens of such cases, which is of great concern to physicians. Most children had a positive test for coronavirus, or confirmed contact with the patient. The clinical symptoms of this condition are very similar to the symptoms of shock with Kawasaki disease and the manifestations of toxic shock syndrome.

The CDC issued a special notice in which it asked doctors to report such cases to health authorities. Criteria of the DMVS were also identified, the definition of which implies the presence of at least four signs:

  • fever within 24 hours;

  • laboratory signs of inflammation;

  • severe course of the disease involving at least three systems and organs: for example, heart, kidney, gastrointestinal tract, etc.

  • lack of alternative probable diagnoses:

  • confirmation of current or recent SARS-CoV-2 infection or contact with a COVID-19 patient for four weeks before the onset of symptoms.

Before additional results are obtained, children who have clinical signs of DMSA should be referred to a pediatric infectious disease specialist, rheumatologist, cardiologist, or intensive care unit as soon as possible. It is also recommended that doctors, with characteristic symptoms, prescribe small immunoglobulin intravenously and aspirin.

Testing and treatment

The recommendations indicate that the criteria for testing for coronavirus in children are determined in each country, depending on current protocols and capabilities. However, the author suggests that public health authorities conduct testing to assess the presence of symptoms in children corresponding to COVID-19: fever, persistent cough, shortness of breath, vomiting, diarrhea. You should also check the presence of the virus in children with severe concomitant diseases and those born prematurely. If the hospitalized child has a negative test, it is recommended to repeat the analysis within the next 48 hours.

Decisions on the use of antiviral therapy should be made individually, depending on the severity of the disease. The recommendations note that studies of the efficacy and safety of antiviral therapy were conducted primarily in adults.

In the list of possible drugs for the treatment of COVID-19, first place is taken by remdesivir, which has encouraging data on the effectiveness and safety of use. Alternatively, hydroxychloroquine without azithromycin may be used. At the same time, it is not recommended to treat children with chloroquine because of the uncertain efficacy and potential cardiac toxicity of the drug. The combination of lopinavir-ritonavir, which has unfavorable pharmacodynamics, also fell into the black list.

The recommendations emphasize that all prescribed antiviral drugs should be taken only under the supervision of a doctor, self-medication is very dangerous for the health of the child.

Vitamin A, which has long been used as an adjunct in the treatment of measles, is also mentioned in the document, and its use was associated with a reduction in the incidence and mortality from measles pneumonia. "Vitamin A deficiency can be associated with impaired humoral and cellular immunity, and even mild vitamin A deficiency can lead to an increased incidence of measles and other respiratory viral infections," the document says.

The document also provides detailed recommendations for treating children with COVID-19 with mild symptoms at home. Such children should be isolated from other family members and pets and receive supportive care. Adults should receive detailed instructions from the doctor, in particular about the alarming symptoms of the disease. Urgent hospitalization may be required with severe shortness of breath or shortness of breath in the child, pain or pressure in the chest area, blue face or lips, and confusion. If the baby is sick, parents should be guarded by "moaning breath", central cyanosis, inability to feed.

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