E. Dondurei, V. Kondratev, L. N. Isankina, N. Y. Kaika, Yu. A. Gaist, V. V. Yesikov, I. Kosenko, V. A. Kaziakhmedov, K. V. Pshenisnov, O. V. Zabirova, S. Dvorak, L. Ivanova, O. Osipova, O. I. Afanasyeva, D. Lioznov
{"title":"2020-2021年圣彼得堡儿童多学科医院新型冠状病毒感染负担","authors":"E. Dondurei, V. Kondratev, L. N. Isankina, N. Y. Kaika, Yu. A. Gaist, V. V. Yesikov, I. Kosenko, V. A. Kaziakhmedov, K. V. Pshenisnov, O. V. Zabirova, S. Dvorak, L. Ivanova, O. Osipova, O. I. Afanasyeva, D. Lioznov","doi":"10.22625/2072-6732-2022-14-3-80-95","DOIUrl":null,"url":null,"abstract":"Objective: To describe the burden of COVID-19 in a children’s multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need.Methods: An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children’s multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition’s structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children’s multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established.Results: The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children’s multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 – other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumnwinter waves of the pandemic and among patients of high school age.Conclusion: New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.","PeriodicalId":226950,"journal":{"name":"Journal Infectology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2022-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"The burden of a new coronavirus infection in a Children’s multidisciplinary hospital in St. Petersburg 2020–2021\",\"authors\":\"E. Dondurei, V. Kondratev, L. N. Isankina, N. Y. Kaika, Yu. A. Gaist, V. V. Yesikov, I. Kosenko, V. A. Kaziakhmedov, K. V. Pshenisnov, O. V. Zabirova, S. Dvorak, L. Ivanova, O. Osipova, O. I. Afanasyeva, D. Lioznov\",\"doi\":\"10.22625/2072-6732-2022-14-3-80-95\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective: To describe the burden of COVID-19 in a children’s multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need.Methods: An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children’s multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition’s structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children’s multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established.Results: The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children’s multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 – other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumnwinter waves of the pandemic and among patients of high school age.Conclusion: New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.\",\"PeriodicalId\":226950,\"journal\":{\"name\":\"Journal Infectology\",\"volume\":\"36 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-10-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal Infectology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.22625/2072-6732-2022-14-3-80-95\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal Infectology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.22625/2072-6732-2022-14-3-80-95","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
摘要
目的:考虑到年龄、疾病严重程度、基础疾病范围和重症监护需求,描述儿童多学科医院在大流行期间两年的COVID-19负担。方法:对2020年3月26日至2021年12月31日住院的6048例18岁以下新冠肺炎患者进行评估。该诊断是在门诊或住院后借助在俄罗斯联邦登记的诊断包通过聚合酶链反应确诊的。介绍了新形势下某儿童多学科医院的工作特点、住院动态、年龄特征和新冠病毒感染严重程度在疫情发展过程中的变化。根据疾病的严重程度,以及重症监护病房的治疗需求和治疗量,分析潜在疾病的结构。确定了儿童多系统炎症综合征(multiple system inflammatory syndrome, MIS-C)在医院条件下发生的频率和主要特征、长期PCR阳性及其对儿童住院时间的影响。结果:SARS-COV-2在圣彼得堡的传播要求儿童多学科医院的工作发生根本性变化。在大流行的两年中,发现了四波新CV儿童住院,在持续时间、强度和肺损伤频率上有所不同,但在严重形式的疾病比例上没有显著差异(1.7-2.8%的病例)。3.6%的病例需要强化治疗,其中只有1/3是由于COVID-19的严重病程,肺病变体积高达100%。在三分之一的病例中,患者有发展为严重形式的风险,三分之一的患者有其他病理。严重的新CV病程明显更常伴有需要呼吸支持、抗凝血和抗炎治疗。导致严重形式和不良结果的因素有:中枢神经系统病理、遗传疾病和畸形、肥胖以及慢性支气管肺病理。只有患有严重基础疾病的儿童在医院死亡(占病例的0.1%)。D-MVS在男孩中更常见(每10例患者中有7例),占整个期间新CV患儿住院病例的1.2%。在1/3的儿童中检测到COVID-19结果的恢复期pcr阳性,在秋冬季大流行期间和高中年龄患者中更为常见。结论:新CV在儿童急性呼吸病理结构中的地位正在逐渐加强。部分SARS-COV-2感染病例伴有广泛的肺损伤,以及独立或在其他传染病结构中出现的严重全身性炎症,不排除诱发各种躯体病理的首发。目前的数据证实,需要增加对不良呼吸道疾病结局高风险儿童的关注。所有严重的COVID-19儿童病例都需要采取个性化的方法,同时考虑到现有的背景疾病和可能的进程选择。misc应被认为是一种多种病因的感染性疾病框架内的全身性炎症反应综合征,与川崎病相鉴别,是全身性疾病的先兆。COVID-19结果的长期pcr阳性需要进一步研究,以解决治疗的必要性和性质,以防止感染在人群中进一步传播。
The burden of a new coronavirus infection in a Children’s multidisciplinary hospital in St. Petersburg 2020–2021
Objective: To describe the burden of COVID-19 in a children’s multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need.Methods: An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children’s multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition’s structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children’s multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established.Results: The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children’s multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 – other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumnwinter waves of the pandemic and among patients of high school age.Conclusion: New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.