Pediatric Respirology and Critical Care Medicine

EDITORIAL
Year
: 2020  |  Volume : 4  |  Issue : 4  |  Page : 49--50

Overcoming COVID-19 in children


Yu-Tsun Su 
 Department of Pediatrics, E-Da Hospital, School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan

Correspondence Address:
Yu-Tsun Su
Department of Pediatrics, E-Da Hospital, School of Medicine for International Students, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City.
Taiwan




How to cite this article:
Su YT. Overcoming COVID-19 in children.Pediatr Respirol Crit Care Med 2020;4:49-50


How to cite this URL:
Su YT. Overcoming COVID-19 in children. Pediatr Respirol Crit Care Med [serial online] 2020 [cited 2021 Dec 7 ];4:49-50
Available from: https://www.prccm.org/text.asp?2020/4/4/49/320778


Full Text



Although the coronavirus disease 2019 (COVID-19) pandemic is still ongoing, the overall number of new daily cases has declined worldwide, especially in the countries that have received a large number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. More than 170 million people have been infected globally with more than 3.5 million deaths. In comparison to the high mortality rate in adults, children are usually asymptomatic or have moderate symptoms.[1] In the review article “Children are not little adults,” Professor Goh reviewed the possible mechanisms for this difference between children and adults. Professor Nong performed a comprehensive review of mucoactive agents that have commonly been used in respiratory diseases for decades, according to the different mechanisms of overproduction and clearance of sputum. In addition, critical infants are an especially fragile pediatric population. Professor Chee reported that the clinical outcomes of critical infants could be improved if interhospital transportations were performed by a specialized transport team and a standard neonatal referral workflow. This new strategy was implemented in July 2019 and is still being used during the COVID-19 pandemic.

The presentations of the COVID-19 infection are less severe in children than in adults. Professor Goh[2] reviewed the pathophysiological mechanisms underlying the differences between children and adults and found that they were caused by a lower number of angiotensin-converting enzyme 2, a strong immune response, and a lower inflammatory response in children. In addition, multisystem inflammatory syndrome, which mainly affects children and adolescents but not adults, is also discussed. Good innate antiviral defenses and lower cytokine responses than adults explain the milder COVID-19 infection in children.

Hsu et al.[3] reviewed mucoactive agents, which are widely used to treat respiratory diseases by changing the properties of sputum or decreasing its production. Professor Nong provides an overview of mucoactive agents according to the different pathophysiologies of mucus hypersecretion and clearance.

Infants are an especially fragile pediatric population. From 2013 to 2016, a complication rate of 44.1% in critically ill infants during interhospital transportations was reported on admission in Hong Kong.[4] After July 2019, a standard neonatal referral workflow and specialized neonatal transport team were implemented at the Hong Kong Children’s Hospital. One year after implementation, Chee et al.[5] reported a marked improvement. Compared to the previous cohort, the rate of documented physiological parameters increased, serious complication rate decreased, and the intervention rate during transport (or within 1h after transport) also significantly decreased. This significant improvement emphasizes the importance of establishing standard protocols including a designated and specialized transport team when a critically ill infant requires interhospital transport and that this is especially important during the COVID-19 pandemic.

The SARS-CoV-2 vaccines are helping to overcome the COVID-19 pandemic. I sincerely hope we can see each other in the near future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kabra S. Treatment of mild to moderate COVID-19 in children. Pediatr Respirol Crit Care Med 2020;4:25-7.
2Goh A. Children are not little adults. Pediatr Respirol Crit Care Med2020;4:51-3.
3Hsu LS, Huang YF, Chiou YH, Nong BR. An overview of mucoactive agents. Pediatr Respirol Crit Care Med 2020;4:54-7.
4Leung KK, Lee SL, Wong MS, Wong WH, Yung TC. Clinical outcomes of critically ill infants requiring interhospital transport to a paediatric tertiary centre in Hong Kong. Pediatr Respirol Crit Care Med 2019;3:28-35.
5Chee YY, Wong RM, Chan GC. Reduction of complications in interhospital transport of critically ill infants: Impact of a standardized neonatal referral workflow and specialized neonatal transport team at the Hong Kong Children’s Hospital. Pediatr Respirol Crit Care Med 2020;4:58-9.