Home Management of Children With COVID-19 in the Emilia-Romagna Region, Italy

Vergine, Gianluca; Fantini, Manuela; Marchetti, Federico; Stella, Marcello; Valletta, Enrico; Biasucci, Giacomo; Lanari, Marcello; Dodi, Icilio; Bigi, Maurizio; Magistà, Anna Maria; Vaienti, Francesca; Cella, Andrea; Affanni, Paola; Re, Maria Carla; Sambri, Vittorio; Esposito, Susanna

doi:10.3389/fped.2020.575290

Cited by 11 publications

(10 citation statements)

References 10 publications

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“…The evidence for this in the literature is still limited, and, in fact, the percentages of admission of positive subjects in pediatric age vary in different cases from 2% to 60% [ 5 , 54 , 55 , 56 ]. A recent study carried out in Emilia-Romagna region, Italy, focused on the importance that adequate territorial management has on reducing the rate of hospitalization of these children [ 57 ]. Territorial management was performed in the so-called Community Health Houses that are health structures able to perform nasopharyngeal swabs for SARS-CoV-2 identification, send samples to the laboratory, collect results and organize adequate home monitoring of children infected with SARS-CoV-2 [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…If the family compliance is inadequate, hospitalization is indicated. Children with chronic diseases, especially chronic lung, heart, neuromuscular and oncological diseases and immunodeficiency disorders, are a heterogeneous group with a potential higher risk of developing a severe disease, although reported cases are few and the overall risk remains low [ 5 , 56 , 57 ]. In these cases, hospitalization is recommended, although, especially in asymptomatic-mild forms, home management with caregiver supervision is reasonable.…”

Section: Resultsmentioning

confidence: 99%

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COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy

Esposito

Marchetti

Lanari

et al. 2021

IJERPH

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Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined. Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group. Literature research was carried out using the keywords “COVID-19” or “SARS-CoV-2” and “children” or “pediatrics” and “prevention” or “diagnosis” or “MIS-C” or “treatment” in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature. The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures. The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge. Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19. Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy

Esposito

Marchetti

Lanari

et al. 2021

IJERPH

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“…This finding suggests that a consistent number of hospital admissions were not due to disease severity but rather to a prudent approach by clinicians toward selected groups of patients (i.e., ex-preterms, neonates), beyond the propensity for their families to seek in hospital medical advice. Furthermore, it emphasizes the need for a robust territorial healthcare system in order to prevent emergency department congestion (9).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results from an Italian Multicenter Study

Garazzino,

Lo Vecchio,

Pierantoni

et al. 2020

SSRN Journal

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Background: Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. Methods:The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020.Results: As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission (p < 0.01) and linearly to length of stay (p = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications (p < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission (p < 0.05).Garazzino et al. SARS-CoV-2 in Children and AdolescentsConclusions: Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.

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“…Although with exceptions, evidence seems to indicate that children have lower susceptibility than adults to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1][2][3]. When infected, children generally remain asymptomatic or develop mild disease [4]. A joint report from the American Academy of Pediatrics and the Children's Hospital Association indicated that on January 28, 2021, a total of 2,816,775 COVID-19 cases in children have been reported in the USA; a value that represents only 12.8% of cases in the USA and 1.2-2.9% of hospitalizations associated with the disease [5].…”

Section: Introductionmentioning

confidence: 99%

What are the risk factors for admission to the pediatric intensive unit among pediatric patients with COVID-19?

2021

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Background Although with exceptions, evidence seems to indicate that children have lower susceptibility than adults to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. When infected, children generally remain asymptomatic or develop mild disease. A small number of pediatric cases required admission to the pediatric intensive care unit (PICU), respiratory support with a mechanical ventilation and additional life-saving interventions. Even if rarely, death can occur. Aim of this manuscript is to highlight the risk factors associated with severe outcome among pediatric patients with COVID-19. Main findings Early identification of SARS-CoV-2-infected children at risk of developing severe COVID-19 is vital for service planning, as severely affected pediatric patients require high-quality care and should be followed only where an adequately structured PICU is available. However, early identification of children who must be carefully monitored for substantial risk of severe COVID-19 remains difficult. An underlying comorbidity and heart involvement are frequently observed in severe paediatric cases. Reduced left ventricular systolic function with an ejection fraction < 60%; diastolic dysfunction; and arrhythmias, including ST segment changes, QTc prolongation, and premature atrial or ventricular beat, are the earliest manifestations of heart involvement. Inclusion of heart enzyme serum levels and evaluation of ventricular function among predictive markers could lead to a more effective evaluation of children at risk with proper selection of those to admit to the PICU and with more adequate treatment in case of more severe clinical manifestations. Conclusions To appropriately manage severe pediatric COVID-19 cases, greater attention should be paid to risk factors in children and adolescents, especially to cardiovascular alterations (e.g., heart enzyme serum levels and evaluation of ventricular function). Further studies are needed and the development of a validated score based on all the most common presumed markers of disease severity seems essential.

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Home Management of Children With COVID-19 in the Emilia-Romagna Region, Italy

Cited by 11 publications

References 10 publications

COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy

COVID-19 Management in the Pediatric Age: Consensus Document of the COVID-19 Working Group in Paediatrics of the Emilia-Romagna Region (RE-CO-Ped), Italy

Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results from an Italian Multicenter Study

What are the risk factors for admission to the pediatric intensive unit among pediatric patients with COVID-19?

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