Update on recommendations for the diagnosis and treatment of SARS-CoV-2 infection in children

Abstract

Since the outbreak of novel coronavirus infection pneumonia in Wuhan City, China, in late 2019, such cases have been gradually reported in other parts of China and abroad. Children have become susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of their immature immune function. As the outbreak has progressed, more cases of novel coronavirus infection/pneumonia in children have been reported. Compared with adults, the impact of SARS-CoV-2 infection in children is less severe, with a lower incidence and susceptibility in children, which results in fewer children being tested, thereby underestimating the actual number of infections. Therefore, strengthening the diagnosis of the disease is particularly important for children, and early and clear diagnosis can determine treatment strategies and reduce the harm caused by the disease to children. According to the Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (trial version 7) issued by National Health Committee and the latest diagnosis and treatment strategies for novel coronavirus infection pneumonia in children, this review summarizes current strategies on diagnosis and treatment of SARS-CoV-2 infection in children.

COVID-19 Pneumonia in Children: From Etiology to Management

“…Hospitalization is indicated when there is a need to ensure supportive therapy (e.g., pharmacological or respiratory support) or in severe forms of pathology ( 13 , 19 , 55 ). Upon entering the ward, performing laboratory blood testing may prove useful, even though it is often non-specific.…”

“…Upon entering the ward, performing laboratory blood testing may prove useful, even though it is often non-specific. In most children it is possible to find: (i) a normal or reduced number of white blood cells, accompanied by lymphocytopenia; (ii) normal or slightly increased C-reactive protein and procalcitonin values (in case of excessive upregulation, a bacterial superinfection should be considered); (iii) slightly increased transaminases and lactic dehydrogenases ( 13 , 19 , 55 ).…”

“…Hospitalized children must have their vitals monitored and have adequate intake of fluids and calories aimed at maintaining a hydro-electrolytic homeostasis. Additionally, bed rest and maintenance of cleared upper airways are recommended ( 13 , 19 , 55 ).…”

“…In case of hypoxia (SpO 2 <95%) without signs of respiratory distress, the administration of oxygen via nasal cannulae or mask is sufficient, while constant monitoring of vital parameters and attending to changes in the acid-base balance may be indicative of clinical worsening ( 13 , 19 , 55 ).…”

“…Although the clinical picture in pediatric populations is more complex, the severity of infection can be clinically classified as follows: asymptomatic, mild, moderate, severe, or critical ( 18 , 19 ) ( Table 1 ). This classification makes the idea that even pediatric patients can experience severe manifestations of the pathology, which must be addressed as early as possible to limit disease progression.…”