Covıd-19’un Çocuk Yoğun Bakımda İzlemi

Abstract

Çocuklarda COVID19 heterojen bir klinik tablo ile ortaya çıkabilir. Çin'in Wuhan kentinde bildirilen ilk ciddi çocukluk çağı enfeksiyonu vakası, gastrointestinal semptomlarla başlayıp belirgin solunum belirtileri göstermemiş, ancak hızla akut solunum sıkıntısı sendromuna ilerlemiştir. Solunum sistemi tutulumu hafif üst solunum yolu bulgularından ağır akut solunum sıkıntısı sendromuna (ARDS) kadar değişkenlik gösterebilir. Ayrıca Nisan 2020’nin sonlarına doğru önce İngiltere ve İtalya sonrasında pek çok ülkeden çocuklarda COVID19 ilişkili bir multisistem inflamatuar sendrom (MIS-C) geliştiği bildirilmiştir. COVID19’a bağlı olarak çocuklarda gelişen MIS-C, COVID19 ile ilişkili nadir ancak ciddi bir durumdur. MIS-C'nin kazanılmış bağışıklığın anormal gelişimi ile enfeksiyöz bir bağışıklık reaksiyonu mu yoksa yeni bir hastalık mı olduğu bilinmemektedir. MIS-C'nin klinik özellikleri Kawasaki hastalığı ve toksik şok sendromuna benzer olabilir. Bunlar arasında sürekli ateş, hipotansiyon, gastrointestinal semptomlar, döküntü, miyokardit ve artmış inflamasyonla ilişkili laboratuvar bulguları bulunur; solunum semptomları her olguda olmayabilir. COVID19 ilişkili septik şok, akut akciğer hasarı, mekanik ventilasyon gereksinimi, ekstrakorporeal solunum ve / veya dolaşım desteği ihtiyacı, akut renal hasar, ağır MIS-C, Kawasaki hastalığı gibi kritik çocuk hastaların çocuk yoğun bakım ünitesinde takip ve tedavisi gerekmektedir. Biz bu bölümde farklı klinik tablolar ile ortaya çıkabilen kritik COVID19 çocuk hastaların çocuk yoğun bakımdaki takip ve tedavisini güncel literatür bilgileri ışığında gözden geçirmeyi planladık.

COVID19 in children may present with a heterogeneous clinical picture. The first serious childhood infection reported in Wuhan, China, started with gastrointestinal symptoms and did not show obvious respiratory symptoms, but quickly progressed to acute respiratory distress syndrome. Respiratory system involvement varies from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome (ARDS). In addition, it has been reported that a multisystem inflammatory syndrome (MIS-C) associated with COVID19 developed in children from England and Italy and then from many countries towards the end of April 2020. MIS-C, which develops in children due to COVID19, is a rare but serious condition. It is not known whether MIS-C is an infectious immune reaction or a new disease with abnormal development of acquired immunity. The clinical features of MIS-C may be similar to Kawasaki disease and toxic shock syndrome. These include laboratory findings associated with persistent fever, hypotension, gastrointestinal symptoms, rash, myocarditis, and increased inflammation; respiratory symptoms may not be present in all cases. Critical pediatric patients such as COVID19- associated septic shock, acute lung injury, need for mechanical ventilation, extracorporeal respiratory and / or circulatory support, acute renal damage, severe MIS-C, Kawasaki disease need to be followed up and treated in the pediatric intensive care unit. In this section, we planned to review the follow-up and treatment of critical COVID19 pediatric patients who may present with different clinical presentations in the pediatric intensive care unit in the light of current literature information. COVID19 in children may present with a heterogeneous clinical picture. The first serious childhood infection reported in Wuhan, China, started with gastrointestinal symptoms and did not show obvious respiratory symptoms, but quickly progressed to acute respiratory distress syndrome. Respiratory system involvement varies from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome (ARDS). In addition, it has been reported that a multisystem inflammatory syndrome (MIS-C) associated with COVID19 developed in children from England and Italy and then from many countries towards the end of April 2020. MIS-C, which develops in children due to COVID19, is a rare but serious condition. It is not known whether MIS-C is an infectious immune reaction or a new disease with abnormal development of acquired immunity. The clinical features of MIS-C may be similar to Kawasaki disease and toxic shock syndrome. These include laboratory findings associated with persistent fever, hypotension, gastrointestinal symptoms, rash, myocarditis, and increased inflammation; respiratory symptoms may not be present in all cases. Critical pediatric patients such as COVID19-associated septic shock, acute lung injury, need for mechanical ventilation, extracorporeal respiratory and / or circulatory support, acute renal damage, severe MIS-C, Kawasaki disease need to be followed up and treated in the pediatric intensive care unit. In this section, we planned to review the follow-up and treatment of critical COVID19 pediatric patients who may present with different clinical presentations in the pediatric intensive care unit in the light of current literature information.