COVID-19 in pediatric patients: a case series from the Bronx, NY
COVID-19 in pediatric patients: a case series from the Bronx, NY
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DOI：
10.1007/s00247-020-04782-2
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发表时间：
2020-07-29
影响因子：
2.3
通讯作者：
Levin, Terry L.
中科院分区：
文献类型：
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作者：
Blumfield, Einat;Levin, Terry L.
背景2019年冠状病毒病(新冠肺炎)主要影响成人，儿童发病率较低。目的报告危重患儿应用新冠肺炎的经验。材料与方法回顾2020年2月25日至5月1日收治的新冠肺炎患儿的临床资料。我们复习了患者的人口统计学、症状、合并症、呼吸支持的要求、急性心肌损伤的证据和胸片。结果19例儿童青少年(年龄2个月~18岁，中位数8岁；男性10例，女性9例；新冠肺炎阳性18例，新冠肺炎阴性伴阳性暴露1例)。主要症状包括发热(89%)、咳嗽(68%)、呼吸窘迫(68%)和呕吐/腹泻(47%)。12例(63%)出现合并症。14例需要重症监护；8例需要插管。两名儿童死亡。5名患者发展为急性心肌炎(中位年龄7岁)；在所有5名患者中，胸片均显示心脏增大、肺充血或间质水肿。在这五人中，有一人(18岁)有潜在的高血压和肥胖，发展为多灶性肺炎和肾功能衰竭。其余4例均为健康儿童；3例(5岁、7岁、8岁)随后诊断为儿童多系统炎症综合征(MIS-C)；1例出现与成人呼吸窘迫综合征一致的肺阴影，3例(60%)无肺实质阴影。14名患者(中位年龄13岁)，大多数合并有并发症，没有急性心肌损伤。13例(93%)胸部X线片显示肺实质病变，主要分布在肺门周围和基底动脉。结论无肺部疾患的心肌炎发生在儿童的最初10年，是一种新发现的多系统炎症综合征，是一种新发现的多系统炎症综合征，是一种值得进一步研究的疾病。肺部疾病在新冠肺炎阳性青少年的第二个十年以肺部疾病为主，在他们的第二个十年中，X线片显示肺阴影主要分布在肺门周围和基底。
Background Coronavirus disease 2019 (COVID-19) primarily affects adults, with a lower incidence in children. Objective To report our experience with critically ill children with COVID-19. Materials and methods We reviewed the medical records of children with COVID-19 who were admitted Feb. 25 to May 1, 2020. We reviewed patient demographics, symptoms, comorbidities, requirement for respiratory support, evidence of acute myocardial injury, and chest radiographs. Results The study included 19 children and adolescents (ages 2 months to 18 years, median 8 years; 10 males, 9 females; 18 COVID-19-positive, 1 COVID-19-negative with positive exposure). Presenting symptoms included fever (89%), cough (68%), respiratory distress (68%) and vomiting/diarrhea (47%). Comorbidities were present in 12 (63%). Fourteen required intensive care; eight required intubation. Two children died. Five patients developed acute myocarditis (median age 7 years); in all five, chest radiographs were notable for cardiomegaly and pulmonary congestion or interstitial edema. Of these five, one (age 18 years), who had underlying hypertension and obesity, developed multifocal pneumonia and renal failure. The other four were previously healthy; three (ages 5 years, 7 years, 8 years) were subsequently diagnosed with multisystemic inflammatory syndrome in children (MIS-C); one developed pulmonary opacities consistent with adult respiratory distress syndrome, three (60%) had no parenchymal pulmonary opacities. Fourteen patients (median 13 years), most with comorbidities, had no acute myocardial injury. Chest radiographs in 13 (93%) demonstrated parenchymal lung disease with a predominant perihilar and basilar distribution. Conclusion Myocarditis without pulmonary disease occurred in children in their first decade as a component of MIS-C, a newly described syndrome of multisystemic inflammation requiring further investigation. Pulmonary disease dominated the radiographic features of COVID-19-positive adolescents in their second decade in whom radiographs demonstrated predominantly perihilar and basilar distribution of lung opacities.