When the new coronary pneumonia hits children, this diagnosis and treatment suggestion, check it quickly!
Compared with adults, children have worse immunity and more complicated contact history (mother-infant, surrounding environment and population). However, compared with adults, there are still not many cases in children, so clinical research is insufficient. However, under such circumstances, medical staff and parents must remain calm and better protect this vulnerable group by accumulating information and experience.
Recently, Professor Liu Li of the Department of Neonatology, the First Affiliated Hospital of Xi’an Jiaotong University, presented the "Pneumonia Diagnosis and Treatment Plan for Novel Coronavirus Infection (Trial Version 5)" and "Recommendations for the Diagnosis and Treatment of Children's Novel Coronavirus Infection in Hubei Province (Trial Version 1)" As a basis, the diagnosis and treatment plan for children with new coronary pneumonia infection is condensed into five key points: the characteristics of children's cases, the diagnosis of children's cases, the principles of handling suspected and confirmed children, the release of isolation and discharge standards, and child protection. Here, we will organize the report video into a text to learn with you.
1. The characteristics of children's cases
Based on the current epidemiological investigation, the incubation period of new coronary pneumonia is 1 to 14 days, mostly 3 to 7 days. The main manifestations are fever and dry cough, and a few are accompanied by nasal congestion, runny nose, diarrhea, shortness of breath and dyspnea. Professor Liu said that children's new coronary pneumonia cases have some common clinical characteristics with adults:
1. Mild patients only show low fever, mild fatigue, etc., without pneumonia;
1. Mild patients only show low fever, mild fatigue, etc., without pneumonia;
2. Severe patients often have difficulty breathing and/or hypoxemia one week after onset;
3. In severe cases, rapid progression to acute respiratory distress syndrome (ARDS), shock, difficult to correct metabolic acidosis, and coagulation dysfunction.
Children's cases also have characteristics that are different from adult cases. Existing clinical data show that with lung imaging examination as the standard for pneumonia severity classification, 63% of children's cases are mild infections. Therefore, compared with adult patients, children's cases have relatively milder symptoms, faster recovery, shorter detoxification time, and better prognosis.
It is worth mentioning that the smallest confirmed child was born only 36 hours. The child’s mother tested positive for the new coronavirus nucleic acid, and the child’s throat swab was also positive 36 hours after birth. This case suggests that there may be a new route of transmission of the new coronavirus-vertical mother-to-child transmission (there is no clear conclusion yet and further research is needed).
In addition, the laboratory test results and chest imaging of children with new coronary pneumonia also have their own characteristics.
In laboratory tests, the total number of white blood cells in the peripheral blood was normal or decreased in the early stage of the disease, and the lymphocyte count decreased; some patients had increased liver enzymes, lactate dehydrogenase kinase, and myoglobin; some critically ill patients had increased troponin; most patients had C reaction Protein and erythrocyte sedimentation rate are elevated, procalcitonin is normal; in severe cases, D-dimer is elevated, and the number of peripheral blood lymphocytes is progressively reduced; in nasopharyngeal swabs, sputum, lower respiratory tract secretions, blood, stool and other specimens The nucleic acid of the new coronavirus can be detected.
In terms of lung imaging, chest X-ray examination should be performed as soon as possible in suspected cases with respiratory symptoms. However, children’s respiratory symptoms can be atypical, and attention should be paid to screening; early multiple small patchy shadows and interstitial changes, which are obvious outside the lungs; development of multiple ground glass nodules in both lungs, and severe lung consolidation (white lung) There is no obvious abnormal lesions on chest CT in children with mild infections.
2. Diagnosis of children's cases
The diagnostic criteria for children with new coronary pneumonia are divided into Hubei Province and outside of Hubei Province.
For suspected cases of children outside Hubei Province, a comprehensive analysis should be combined with epidemiological history and clinical manifestations. In epidemiology, the following information should be mastered:
Have a history of residence in Wuhan City and surrounding areas, or other communities with case reports within 14 days before the onset;
A history of contact with a person who tested positive for the new coronavirus within 14 days before the onset of illness;
Contact with patients with fever and respiratory symptoms who came to Wuhan and surrounding areas or from communities with case reports within 14 days before the onset of illness;
Cluster disease.
In terms of clinical manifestations, attention should be paid to: fever and/or respiratory symptoms; chest imaging features and laboratory findings. Those who meet any one of the epidemiological history, and any two of the clinical manifestations, have no clear epidemiological history, and meet three of the clinical manifestations, can be diagnosed as suspected cases.
The confirmed case should have one of the following etiological evidence: real-time fluorescent reverse transcription-polymerase chain reaction (RT-PCR) detection of new coronavirus nucleic acid positive in respiratory or blood samples; viral gene sequencing of respiratory or blood samples and known The new coronavirus is highly homologous.
It is important to note that for newborns delivered by mothers with a history of new coronavirus infection within 14 days before delivery and 28 days after delivery, or directly exposed to other contacts with a history of infection during the newborn period, regardless of symptoms, All suspected cases of infection should be considered.
The diagnostic criteria for suspected cases in Hubei Province are different from those outside the province, and the imaging features of pneumonia are no longer emphasized. Any one of the epidemiological history, or no epidemiological history, but also meets 2 of the clinical manifestations, can be diagnosed as a suspected case. Suspected cases with imaging features of pneumonia can be classified as clinically diagnosed cases.
The confirmed case should have one of the following etiological evidence: real-time fluorescent reverse transcription-polymerase chain reaction (RT-PCR) detection of new coronavirus nucleic acid positive in respiratory or blood samples; viral gene sequencing of respiratory or blood samples and known The new coronavirus is highly homologous.
It is important to note that for newborns delivered by mothers with a history of new coronavirus infection within 14 days before delivery and 28 days after delivery, or directly exposed to other contacts with a history of infection during the newborn period, regardless of symptoms, All suspected cases of infection should be considered.
The diagnostic criteria for suspected cases in Hubei Province are different from those outside the province, and the imaging features of pneumonia are no longer emphasized. Any one of the epidemiological history, or no epidemiological history, but also meets 2 of the clinical manifestations, can be diagnosed as a suspected case. Suspected cases with imaging features of pneumonia can be classified as clinically diagnosed cases.
The clinical classification of children's new coronary pneumonia is 3 types-light, normal and severe:
1. Mild: The clinical symptoms are mild, and there is no pneumonia in imaging;
2. Ordinary type: symptoms such as fever and respiratory tract, pneumonia can be seen on imaging;
2. Ordinary type: symptoms such as fever and respiratory tract, pneumonia can be seen on imaging;
3. Severe: fever, cough, dyspnea or shortness of breath.
It should be pointed out that critical cases are temporarily not emphasized in the classification of children. Once life-threatening changes occur, it is recommended to classify and deal with ARDS and septic shock.
3. Principles of handling suspected and confirmed children
After the children are classified, how should they be treated? Professor Liu pointed out that, first of all, the treatment site should be determined according to the condition. Suspected cases should be treated in isolation in a single room, and confirmed cases can be admitted to the same ward. Air isolation for contact, droplets, and aerosols should be implemented. Critical cases should be admitted to ICU for treatment as soon as possible.Secondly, individualized treatment should be used according to the condition of the child. General treatment includes the following methods:
1. Stay in bed, support treatment, and pay close attention to vital signs.
2. Monitor routine inspection items, such as hematuria, biochemical indicators, coagulation function, C-reactive protein, arterial blood gas analysis, chest imaging, etc.
3. Oxygen therapy: nasal catheters or masks for high-flow oxygen inhalation through the nose, non-invasive or invasive mechanical ventilation, etc. for children with hypoxemia.
4. Antiviral treatment: There is no effective antiviral drug. For critically ill children, refer to adult medication, and for mild cases, use interferon atomization.
5. Antibacterial treatment: avoid blindly or inappropriately using antibacterial drugs. Use promptly when there is evidence of secondary bacterial infection.
6. Glucocorticoid therapy: avoid routine use. The timing of use is when any 3 of the following 4 items are available: a. Fever is above 38.5℃ for ≥3 days; b. C-reactive protein ≥30mg/l; c. Serum ferritin ≥1000μg/l; d. Both lungs Diffuse lesions.
7. Immune globulin: if severe systemic inflammatory response syndrome occurs, "jing C" can be used.
8. Traditional Chinese medicine treatment: At present, there are Chinese medicine programs that apply syndrome differentiation and treatment for adults, and children can refer to it. But it is not recommended to use traditional Chinese medicine injection preparations.
9. Psychotherapy: Strengthen psychological counseling.
The principle of treatment of severe cases is to actively prevent and treat complications on a symptomatic basis, treat underlying diseases, prevent secondary infections, and provide timely organ and functional support. Respiratory support such as non-invasive ventilation and high-frequency ventilation (HFOV) for children with ARDS and respiratory failure, and tracheal intubation for severe cases. The tracheal intubation should avoid airborne transmission. If necessary, prone position ventilation or extracorporeal lung membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), etc.; for severe pneumonia complicated by septic shock, volume resuscitation or application of vasoactive drugs.
Fourth, release isolation and discharge standards
How to evaluate the effectiveness of treatment?
For children, they can be released from isolation, discharged from hospital, or transferred to the corresponding department for treatment of other diseases according to their condition:
1. Body temperature returned to normal for more than 3 days;
2. Lung imaging showed obvious absorption of inflammation;
3. Two consecutive respiratory tract pathogenic nucleic acid tests were negative (the sampling interval was at least 1 day).
1. Body temperature returned to normal for more than 3 days;
2. Lung imaging showed obvious absorption of inflammation;
3. Two consecutive respiratory tract pathogenic nucleic acid tests were negative (the sampling interval was at least 1 day).
For newborns, the following standards must be met:
1. Asymptomatic infection: samples of upper respiratory tract secretions are collected every 2 days to test for viral nucleic acid, and it is negative for 2 consecutive times (at least 24 hours);
2. Upper respiratory tract infection: body temperature returned to normal for more than 3 days, symptoms improved, and upper respiratory tract secretions collected twice (at least 24 hours) tested negative for viral nucleic acid;
2. Upper respiratory tract infection: body temperature returned to normal for more than 3 days, symptoms improved, and upper respiratory tract secretions collected twice (at least 24 hours) tested negative for viral nucleic acid;
3. Body temperature returned to normal for more than 3 days, respiratory symptoms improved, lung imaging showed obvious absorption of inflammation, upper respiratory tract (nasopharyngeal swab) and lower respiratory tract secretion specimens (sputum) collected twice (at least 24 hours) Detection of viral nucleic acid was negative.
Five, child protection
During the epidemic, how should families with children protect themselves?
Professor Liu Li suggested that during this special period, children's families should open more windows for ventilation, throw away disposable items such as paper towels and wet wipes used by children in a special trash can, and regularly disinfect all kinds of items in the home and the surrounding environment; Measure the temperature of children at home every day, and immediately go to the designated hospital for pneumonia prevention and treatment if symptoms such as fever, anorexia, and diarrhea appear.At the same time, you should try to avoid taking your children out to visit relatives and friends, gatherings, and dinners. Keep the home environment clean and teach children to wash their hands frequently. You must bring disposable hand sanitizer and wear a mask when you go out. In the selection of children's masks, ordinary disposable masks and N95 masks can be used, but N95 masks with special air valve design should be avoided for children under 1 year old to prevent suffocation. Parents should also hand over the children to master cough etiquette. When coughing or sneezing, they should use tissues, handkerchiefs, sleeves or elbows to cover their mouth and nose. If they are covered with their hands, they should wash their hands immediately to maintain hygiene.
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