IMPROVING SHARED DECISION-MAKING AND TREATMENT PLANNING THROUGH PREDICTIVE MODELING: CLINICAL INSIGHTS ON VENTRAL HERNIA REPAIR

Yagnik PJ, Umscheid J, Khan AW, Ali M, Bhatt P, Desai PH. Clin Pediatr 2020. https://doi.org/10.1177/0009922820920017

In this review of the literature, the authors aimed to gather available data for the pediatric population affected by the novel coronavirus based on published literature from January 1, 2020, through March 19, 2020. It was noted initially that COVID-19 was known as an acute respiratory virus usually affecting the elderly and those with comorbidities. The authors conducted a literature review using PubMed with variations of the term "novel coronavirus" and various for term child. They found 62 studies and screened them for common clinical presentations, diagnostic tests, treatments, and complications.

They found only 2 large studies had been published describing characteristics of COVID-19. The first of these studied 2143 children younger than 18 years based on their symptoms and history of exposure. Of these children, 731 were laboratory-confirmed cases of SARS-CoV-2 infection with a median age of 10 years, with boys more commonly affected 57.5% (n = 420). Approximately 13% were asymptomatic (n = 94), 43.1% had mild symptoms similar to an upper respiratory tract infection, 41% had symptoms without hypoxia, 2.5% had infection with hypoxia, and 0.4% (n = 3) were classified as having critical infection. The children classified as having a critical infection had respiratory failure and a combination of a systemic dysfunction.

The second largest study involved 171 children younger than 16 years with a laboratory-confirmed SARS-CoV-2 with a median age of 6.7 years; 60.8% were males. There were fever (>37.5[degrees]C) in 41.5% (n = 71) and temperature of greater than 39[degrees]C in 8.8% (n = 16). Cough was present in 48.5% (n = 83) and pharyngeal edema in 46.2% (n = 79). Pneumonia was the most common presenting diagnosis in those younger than 1 year and upper respiratory tract infection in ages 1 to 5 years; 15.8% (n = 27) were asymptomatic; 3 of the children required intensive care with mechanical ventilation, and all 3 had a preexisting condition. Hypoxia was seen in 2.3% of the children.

The researchers concluded mortality was rare in the pediatric COVID-19 studies. With the first study, a 14-year-old boy died, and in the second study, a 10-month-old with intussusception and organ failure died. The also concluded that most children who were infected with COVID-19 were asymptomatic.