Updated diagnosis, treatment and prevention of COVID-19 in children: experts’ consensus statement (condensed version of the second edition)

Abstract

In the early February, 2020, we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis, treatment and prevention of coronavirus disease 2019 (COVID-19) in children, which has been published in this journal. With accumulated experiences in the diagnosis and treatment of COVID-19 in children, we have updated the consensus statement and released the second edition recently. The current version in English is a condensed version of the second edition of consensus statement on diagnosis, treatment and prevention of COVID-19 in children. In the current version, diagnosis and treatement criteria have been optimized, and early identification of severe and critical cases is highlighted. The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice. This version of experts consensus will be valuable for better prevention, diagnosis and treatment of COVID-19 in children worldwide.

SARS-CoV-2 infection in a patient with propionic acidemia

“…Systemic reviews of COVID-19 in pediatric patients suggests that the clinical course of SARS CoV-2 infection in children is milder than in adults [ 12 , 19 , 20 ]. However, the impact of this infection on the clinical status of children with an inborn metabolic disorder is not well known [ 16 , 19 ].…”

“…In general, children appear to have a milder clinical course compared to adults [ 8 – 11 ]. Little is known about SARS-CoV-2 infection in children with comorbidities (such as congenital heart, lung and airway diseases, chronic heart and kidney diseases, malnutrition, tumors, diabetes, immunodeficiency or hypoimmunity) and little information is available on the effects of the infection in pediatric patients with congenital inborn errors of metabolism (IEM) [ 8 , 12 ]. However, emerging guidelines have been proposed to manage eventual SARS-Co V2 infection in lysosomal diseases and on inherited heart diseases [ 13 – 15 ].…”

COVID-19 infection in children and adolescents

“…In addition, a Chinese group of paediatric experts published and reviewed consensus criteria for management of COVID-19 infection in paediatric population (Shen et al, 2020). Thus, the authors present general management recommendations for COVID-19 infection in children, using a combination of available publications (Figure 3)…”

“…In the case of respiratory distress that occurs despite nasal cannulae or mask oxygenation, heated humidified high flow nasal cannula non-invasive respiratory support, non-invasive ventilation such as continuous positive airway pressure, or non-invasive high-frequency Review © 2020 MA Healthcare Ltd ventilation is recommended (Shen et al, 2020). If there is no improvement, mechanical ventilation with endotracheal intubation and a protective lung ventilation strategy should be adopted as a last resort.…”

Cardiac workup and monitoring in hospitalised children with COVID- 19

“…Patients who are at risk for severe infection and may be more likely to require admission to the ICU include infants and those with underlying comorbidities such as lung disease, cardiovascular disease, chronic kidney disease, diabetes, and metabolic or immune disorders. 27,28 Based on consensus opinion at our institution, we suggest that special consideration should be given to patients with pulmonary hypertension, unrepaired complex congenital heart disease, cyanotic heart disease with oxygen saturations less than 85%, ventricular dysfunction requiring medical therapy, and history of heart transplantation on immunosuppressive medications. Due to their higher risk profile, these patients may warrant a more complete evaluation than those without pre-existing conditions.…”