Please wait a minute...
J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (2): 139-146    DOI: 10.3785/j.issn.1008-9292.2020.02.01
    
Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition)
CHEN Zhimin(),FU Junfen*(),SHU Qiang*(),WANG Wei,CHEN Yinghu,HUA Chunzhen,LI Fubang,LIN Ru,TANG Lanfang,WANG Tianlin,WANG Yingshuo,XU Weize,YANG Zihao,YE Sheng,YUAN Tianming,ZHANG Chenmei,ZHANG Yuanyuan
Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, China
Download: HTML( 254 )   PDF(1074KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and Mycoplasma pneumoniae infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.



Key wordsCoronavirus disease 2019      Severe acute respiratory syndrome coronavirus 2      Child      Diagnosis      Treatment      Guideline     
Received: 11 February 2020      Published: 13 February 2020
CLC:  R511  
Corresponding Authors: FU Junfen,SHU Qiang     E-mail: zmchen@zju.edu.cn;fjf68@zju.edu.cn;shuqiang@zju.edu.cn
Cite this article:

CHEN Zhimin,FU Junfen,SHU Qiang,WANG Wei,CHEN Yinghu,HUA Chunzhen,LI Fubang,LIN Ru,TANG Lanfang,WANG Tianlin,WANG Yingshuo,XU Weize,YANG Zihao,YE Sheng,YUAN Tianming,ZHANG Chenmei,ZHANG Yuanyuan. Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition). J Zhejiang Univ (Med Sci), 2020, 49(2): 139-146.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.02.01     OR     http://www.zjujournals.com/med/Y2020/V49/I2/139


儿童2019冠状病毒病(COVID-19)诊疗指南(第二版)

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染导致的2019冠状病毒病(COVID-19)已引起全球大流行。人群对SARS-CoV-2普遍易感,儿童也不例外,但病情相对较轻。与确诊或可疑COVID-19患者接触史或聚集性发病等流行病学证据及临床表现是COVID-19诊断的主要依据。儿童COVID-19多以发热、咳嗽为主要症状,血白细胞总数正常或减少,胸部影像学以间质性肺炎为特征,与其他呼吸道病毒感染及肺炎支原体感染相似,确诊有赖于实时荧光PCR等方法检测呼吸道标本病毒核酸。临床处理强调早识别、早隔离、早诊断及早治疗。轻型和普通型患儿以对症治疗为主;重型和危重型患儿应根据病情给予吸氧、抗病毒药物、抗菌药物、糖皮质激素、机械通气及体外膜氧合等治疗,严格掌握指征与时机,并通过多学科协作诊疗及时调整治疗方案。


关键词: 2019冠状病毒病,  严重急性呼吸综合征冠状病毒2,  儿童,  诊断,  治疗,  指南 
[1]   GORBALENYA A E. Severe acute respiratory syndrome-related coronavirus-the species and its viruses, a statement of the Coronavirus Study Group[J/OL]. BioRxiv, 2020. DOI: 10.1101/2020.02.07.937862.
[2]   WHO. Novel coronavirus(2019-nCoV) situation report-22[EB/OL]. (2020-02-11)[2020-02-11]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.
[3]   CHEN Z M , FU J F , SHU Q et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus[J]. World J Pediatr, 2020,
doi: 10.1007/s12519-020-00345-5
[4]   中华人民共和国国家卫生健康委办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第五版)[A/OL].国卫办医函[2020] 103号.(2020-02-04)[2020-02-11].http://www.gov.cn/zhengce/zhengceku/2020-02/05/content_5474791.htm.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment program of novel coronavirus infected pneumonia(5th trial ed)[A/OL]. No.103[2020] of the General Office of the National Health Commission. (2020-02-04)[2020-02-11]. http://www.gov.cn/zhengce/zhengceku/2020-02/05/content_5474791.htm. (in Chinese)
[5]   ZHU N , ZHANG D , WANG W et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020,
doi: 10.1056/NEJMoa2001017
[6]   CHAN J F , YUAN S , KOK K H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission:a study of a family cluster[J]. Lancet, 2020,
doi: 10.1016/S0140-6736(20)30154-9
[7]   方峰, 罗小平 . 面对2019新型冠状病毒感染重大疫情:儿科医生的思考[J]. 中华儿科杂志, 2020, 58 (2): 81- 85
FANG Feng , LUO Xiaoping . Facing the pandemic of 2019 novel coronavirus infections:the pediatric perspectives[J]. Chinese Journal of Pediatrics, 2020, 58 (2): 81- 85
doi: 10.3760/cma.j.issn.0578-1310.2020.02.001
[8]   陈锋, 刘智胜, 张芙蓉 et al. 中国首例儿童危重型新型冠状病毒肺炎[J]. 中华儿科杂志, 2020, 58
CHEN Feng , LIU Zhisheng , ZHANG Furong et al. First case of severe childhood novel coronavirus pneumonia in China[J]. Chinese Journal of Pediatrics, 2020, 58
doi: 10.3760/cma.j.issn.0578-1310.2020.0005
[9]   莫茜, 秦炜, 傅启华 et al. 正确认识新冠病毒核酸检测的影响因素[J]. 中华检验医学杂志, 2020, 43
MO Xi , QIN Wei , FU Qihua et al. Understanding the influence factors in viral nucleic acid test of 2019 novel coronavirus (2019-nCoV)[J]. Chinese Journal of Laboratory Medicine, 2020, 43
doi: 10.3760/cma.j.issn.1009-8158.2020.0002
[10]   HUANG C , WANG Y , LI X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395 (10223): 497- 506
doi: 10.1016/S0140-6736(20)30183-5
[11]   PERLMAN S . Another decade, another coronavirus[J]. N Engl J Med, 2020,
doi: 10.1056/NEJMe2001126
[12]   马慧静, 邵剑波, 王永姣 et al. 新型冠状病毒肺炎儿童高分辨率CT表现[J]. 中华放射学杂志, 2020, 54
MA Huijing , SHAO Jianbo , WANG Yongjiao et al. High resolution CT features of novel coronavirus pneumonia in children[J]. Chinese Journal of Radiology, 2020, 54
doi: 10.3760/cma.j.issn.1005-1201.2020.0002
[13]   中华人民共和国国家卫生健康委员会, 国家中医药管理局 . 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12 (1): 6- 13
National Health Commission of the People's Republic of China , National Administration of Traditional Chinese Medicine Chinese . Guideline for diagnosis and treatment of community-acquired pneumonia in children (2019 version)[J]. Journal of Clinical Infectious Diseases, 2019, 12 (1): 6- 13
doi: 10.3760/cma.j.issn.1674-2397.2019.01.002
[14]   CHU C M , CHENG V C , HUNG I F et al. Role of lopinavir/ritonavir in the treatment of SARS:initial virological and clinical findings[J]. Thorax, 2004, 59 (3): 252- 256
doi: 10.1136/thorax.2003.012658
[15]   ARABI Y M , ALOTHMAN A , BALKHY H H et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial):study protocol for a randomized controlled trial[J]. Trials, 2018, 19 (1): 81
doi: 10.1186/s13063-017-2427-0
[16]   陆权, 王雪峰, 钱渊 et al. 儿童病毒性肺炎中西医结合诊治专家共识(2019年制定)[J]. 中国实用儿科杂志, 2019, 34 (10): 801- 807
LU Quan , WANG Xuefeng , QIAN Yuan et al. Expert consensus on integrated traditional Chinese and western medicine in the diagnosis and treatment of viral pneumonia in children (2019)[J]. Chinese Journal of Practical Pediatrics, 2019, 34 (10): 801- 807
doi: 10.19538/j.ek2019100601
[17]   ARABI Y M , MANDOURAH Y , AL-HAMEED F et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome[J]. Am J Respir Crit Care Med, 2018, 197 (6): 757- 767
doi: 10.1164/rccm.201706-1172OC
[18]   World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected[EB/OL].(2020-01-11)[2020-02-11]. https://www.who.int/internal-publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.
[19]   中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会 . 儿童社区获得性肺炎管理指南(2013修订)(上)[J]. 中华儿科杂志, 2013, 51 (10): 745- 752
Chinese Medical Association Society of Pediatrics Subspecialty Group of Respiratory Diseases , The The Editorial Board of Chinese Journal of Pediatrics . Guidelines for management of community acquired pneumonia in children(the revised edition of 2013)(Ⅰ)[J]. Chinese Journal of Pediatrics, 2013, 51 (10): 745- 752
doi: 10.3760/cma.j.issn.0578-1310.2013.10.006
[20]   中华人民共和国国家卫生健康委办公厅, 国家中医药管理局办公室.儿童腺病毒肺炎诊疗规范(2019年版)[A/OL].(2019-06-25)[2020-02-11].http://www.gov.cn/zhengce/zhengceku/2019-11/19/content_5453484.htm.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Guideline for diagnosis and treatment of adenoviral pneumonia in children (2019)[A/OL]. (2019-06-25)[2020-02-11]. http://www.gov.cn/zhengce/zhengceku/2019-11/19/content_5453484.htm. (in Chinese)
[21]   中国医师协会体外生命支持专业委员会儿科学组, 中国医师协会儿童重症医师分会体外生命支持委员会, 中华医学会儿科分会急救学组 et al. 体外膜氧合支持儿科暴发性心肌炎专家共识[J]. 中华急诊医学杂志, 2020, 29 (1): 36- 41
Pediatrics Group of Extracorporeal Life Support Committee , Extracorporeal Life Support Committee of Pediatric Critical Care Society, Chinese Medical Doctor Association , Emergency Medicine Group, Chinese Pediatric Society, Chinese Medical Association et al. Expert consensus on extracorporeal membrane oxygenation in support of fulminant myocarditis in children[J]. Chinese Medical Doctor Association, 2020, 29 (1): 36- 41
doi: 10.3760/cma.j.issn.1671-0282.2020.01.005
[22]   中华人民共和国国家卫生健康委员会.新型冠状病毒感染的肺炎病例转运工作方案(试行)[A/OL].国卫办医函[2020] 76号.(2020-01-27)[2020-02-11].http://www.gov.cn/zhengce/zhengceku/2020-01/29/content_5472894.htm.
National Health Commission of the People's Republic of China. Transportation of patients with coronavirus disease 2019(trail version)[A/OL].No.76[2020] of the General Office of the National Health Commission. (2020-01-27)[2020-02-11]. http://www.gov.cn/zhengce/zhengceku/2020-01/29/content_5472894.htm. (in Chinese)
[1] WANG Jincheng,LIU Jinpeng,WANG Yuanyuan,LIU Wei,CHEN Xiaoqun,SUN Chao,SHEN Xiaoyong,WANG Qidong,WU Yaping,LIANG Wenjie,RUAN Lingxiang. Dynamic changes of chest CT imaging in patients with COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 191-197.
[2] ZHANG Xiaoyan, SUN Wei, SHANG Shiqiang, MAO Jianhua, FU Junfen, SHU Qiang, JIANG Kewen. Principles and suggestions on biosafety protection of biological specimen preservation during prevalence of COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 170-177.
[3] CAO Shengli,FENG Peihua,SHI Pengpeng. Study on the epidemic development of COVID-19 in Hubei province by a modified SEIR model[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 178-184.
[4] CHEN Jun,LIU Danping,LIU Li,LIU Ping,XU Qingnian,XIA Lu,LING Yun,HUANG Dan,SONG Shuli,ZHANG Dandan,QIAN Zhiping,LI Tao,SHEN Yinzhong,LU Hongzhou. A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 215-219.
[5] XU Kaijin,CAI Hongliu,SHEN Yihong,NI Qin,CHEN Yu,HU Shaohua,LI Jianping,WANG Huafen,YU Liang,HUANG He,QIU Yunqing,WEI Guoqing,FANG Qiang,ZHOU Jianying,SHENG Jifang,LIANG Tingbo,LI Lanjuan. Management of COVID-19: the Zhejiang experience[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 147-157.
[6] JIANG Saiping,LI Lu,RU Renping,ZHANG Chunhong,RAO Yuefeng,LIN Bin,WANG Rongrong,CHEN Na,WANG Xiaojuan,CAI Hongliu,SHENG Jifang,ZHOU Jianying,LU Xiaoyang,QIU Yunqing. Pharmaceutical care for severe and critically ill patients with COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 158-169.
[7] LI Xin,DAI Tian,WANG Hong,SHI Junnian,YUAN Wei,LI Jing,CHEN Lijun,ZHANG Tianming,ZHANG Shanshan,KONG Yan,YUE Ning,SHI Hui,HE Yuping,HU Huifang,LIU Furong,YANG Caixia. Clinical analysis of suspected COVID-19 patients with anxiety and depression[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 203-208.
[8] LUO Song,YANG Lijuan,WANG Chun,LIU Chuanmiao,LI Dianming. Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 227-231.
[9] HONG Dongsheng,NI Jian,SHAN Wenya,LI Lu,HU Xi,YANG Hongyu,ZHAO Qingwei,ZHANG Xingguo. Establishment of a rapid identification of adverse drug reaction program in R language implementation based on monitoring data[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 253-259.
[10] ZHONG Qi,LI Zhi,SHEN Xiaoyong,XU Kaijin,SHEN Yihong,FANG Qiang,CHEN Feng,LIANG Tingbo. CT imaging features of patients with different clinical types of COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 198-202.
[11] KANG Xianhui,ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong,ZHU Shengmei. Anesthesia management in cesarean section for patient with COVID-19: a case report[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 249-252.
[12] CHEN Xu,LI Yang,WANG Jinxi,CAI Hongliu,CAO Hongcui,SHENG Jifang. Pregnant women complicated with COVID-19: a clinical analysis of 3 cases[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 240-244.
[13] SHEN Lihua,HUANG Fei,CHEN Xiang,XIONG Zuan,YANG Xiaoyu,LI Hui,CHENG Feng,GUO Jian,GONG Guofu. Diagnostic efficacy of three test kits for SARS-CoV-2 nucleic acid detection[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 185-190.
[14] ZHAGN Sheng,LI Danping,CHEN Huazhong,ZHENG Dan,ZHOU Yiping,CHEN Baoguo,SHI Weiwu,LIN Ronghai. Dynamic inflammatory response in a critically ill COVID-19 patient treated with corticosteroids[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 220-226.
[15] LI Youjiang,HU Yingying,ZHANG Xiaodong,YU Yuanyuan,LI Bin,WU Jianguo,WU Yingping,XIA Xiaoping,XU Jian. Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 270-274.