Pediatric surgery during the COVID-19 pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on pediatric surgery. The infection is often asymptomatic and atypical in children, while overlapping presentations with other infectious diseases generate additional diagnostic challenges. The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting. Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts. Decision-making can be assisted by classifying cases as elective, urgent, or an emergency according to the risks of delaying their surgical management. A workflow diagram should ideally guide the management of all cases from admission to discharge. When surgery is necessary, all staff should use appropriate personal protective equipment, and high-risk practices, such as aerosol-generating tools or procedures, should be avoided if possible. Furthermore, carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units. For example, surgical teams can be divided into small weekly rotating groups, and healthcare workers should be continuously monitored for COVID-19 symptoms. Additionally, team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use. Isolated operating rooms, pediatric intensive care units, and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases. Finally, transportation of patients should be minimal and follow designated short routes. All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.

The impact of the initial wave of COVID-19 pandemic on children under endoscopic esophageal dilatation protocol: a single center study

“…Also, symptomatic cases in the pediatric population had atypical presentations. With regards to surgery, it has been reported that the invasive nature of surgery may possibly contribute to the transmission of COVID-19 between patients and medical staff [ 15 ]. Furthermore, perioperative stress and associated immune dysregulation may exacerbate the clinical condition in COVID-19 patients [ 16 ].…”

Incidental radiological findings suggestive of COVID-19 in asymptomatic patients

“…They concluded that chest CT had a low specificity in differentiating COVID-19 pneumonia from other types of pneumonia and recommended that COVID-19 diagnosis be confirmed by clinical and laboratory examinations. Dedeilia et al [ 61 ] reported that COVID-19 had a major effect on pediatric surgery, because children with COVID-19 are usually asymptomatic or have mild symptoms. Furthermore, many upper respiratory infections in children, such as influenza virus, rhinovirus, and others, present the same symptoms as COVID-19, and coinfection of SARS-CoV-2 may also occur[ 4 , 28 , 62 ].…”

Pediatric cataract surgery practices in the COVID-19 era: Perspectives of a tertiary care institute in Northern India

“…The surgical teams were divided into small weekly rotating groups, and the health care workers were continuously monitored for symptoms of COVID-19. [ 11 ] If any health care professional developed any symptom, he/she was advised testing as soon as possible, along with isolation for 14 days. The surgical technique remained the same except for the fact that an additional preservative-free intracameral moxifloxacin antibiotic was given at the end of the surgery to safeguard against any infectious complication (endophthalmitis) which might require another surgery.…”