Evolución clínica de los casos de infección por COVID-19 en neopediatría: scoping review

Costa, Thatiane Monick de Souza; Santos, Kauanny Vitoria Gurgel do; Rocha, Rodrigo Rhuan Andrade; Oliveira, Eloysa dos Santos; Dantas, Rodrigo Assis Neves; Dantas, Daniele Vieira

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Revista Brasileira de Enfermagem

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REVIEW • Rev. bras. enferm. 74 (Suppl 1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0662 copiar

Evolución clínica de los casos de infección por COVID-19 en neopediatría: scoping review

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

mapear el conocimiento sobre los hallazgos clínicos, el tratamiento y la evolución de los recién nacidos y niños infectados por COVID-19.

Métodos:

scoping review realizada en ocho bases de datos y en un motor de búsqueda electrónico en abril de 2020.

Resultados:

los 12 estudios analizados mostraron que los principales hallazgos clínicos en esta población fueron congestión nasal, fiebre, dificultad respiratoria, diarrea, fatiga, tos seca, aumento de proteína C reactiva, leucopenia, linfopenia, trombocitopenia, procalcitonina elevada, opacidad vítrea bilateral mate, consolidación pulmonar y neumonía. Como tratamiento se utilizaron antivirales, soporte respiratorio, terapia inmunomoduladora, glucocorticoides, antibióticos e interferón alfa. La presencia de una cura con el alta hospitalaria está presente en la mayoría de los casos.

Consideraciones finales:

la mayoría de los pacientes requirieron hospitalización, pero evolucionaron hasta curarse. Este estudio proporcionó una mayor base científica al mostrar los hallazgos clínicos, el tratamiento y los resultados en pacientes neopediatricos con COVID-19.

Descriptores:
Coronavirus; Recién Nacido; Pediatría; Evolución Clínica; Infecciones

Data sources	Adopted syntax
MEDLINE*	("Infant, Newborn" [All Fields] AND "coronavirus" [All Fields]) AND ("Infant, Newborn" [All Fields] AND "COVID-19" [All Fields]) AND ("Infant, Newborn" [All Fields] AND "SARS-CoV-2" [All Fields]) AND ("Pediatrics" [All Fields] AND "coronavirus" [All Fields]) AND ("Pediatrics" [All Fields] AND "COVID-19" [All Fields]) AND ("Pediatrics" [All Fields] AND "SARS-CoV-2" [All Fields])
Scopus†	(KEY ("Infant, Newborn") AND KEY ("coronavirus")) AND (KEY ("Infant, Newborn" AND TITLE-ABS-KEY ("COVID-19")) AND (KEY ("Infant, Newborn") AND TITLE-ABS-KEY ("SARS-CoV-2")) AND (KEY ("Pediatrics") AND KEY ("coronavirus")) AND (KEY ("Pediatrics") AND TITLE-ABS-KEY ("COVID-19")) AND (KEY ("Pediatrics") AND TITLE-ABS-KEY ("SARS-CoV-2"))
CINAHL‡	(Infant, Newborn AND COVID-19) AND (Infant, Newborn AND coronavirus) AND (Infant, Newborn AND SARS-CoV-2) AND (Pediatrics AND COVID-19) AND (Pediatrics AND Coronavirus) AND (Pediatrics AND SARS-CoV-2)
Web of Science§	(TOPIC: (Infant, Newborn) AND TOPIC: (Coronavirus)) AND (TOPIC: (Infant, Newborn) AND TOPIC: (COVID-19)) AND (TOPIC: (Infant, Newborn) AND TOPIC: (SARS-CoV-2)) AND (TOPIC: (Pediatrics) AND TOPIC: (Coronavirus)) AND (TOPIC: (Pediatrics) AND TOPIC: (COVID-19)) AND (TOPIC: (Pediatrics) AND TOPIC: (SARS-CoV-2))
Cochrane Library\|\|	(Infant, Newborn) in Title Abstract Keyword AND (Coronavirus) in Title Abstract Keyword AND (Infant, Newborn) in Title Abstract Keyword AND (COVID-19) in Title Abstract Keyword AND (Infant, Newborn) in Title Abstract Keyword AND (SARS-CoV-2) in Title Abstract Keyword AND (Pediatrics) in Title Abstract Keyword AND (Coronavirus) in Title Abstract Keyword AND (Pediatrics) in Title Abstract Keyword AND (COVID-19) in Title Abstract Keyword AND (Pediatrics) in Title Abstract Keyword AND (SARS-CoV-2) in Title Abstract Keyword
LILACS¶	Infant, Newborn [Words] AND coronavirus [Words] AND Infant, Newborn [Words] AND COVID-19 [Words] AND Infant, Newborn [Words] AND SARS-CoV-2 [Words] AND Pediatrics [Words] AND Coronavirus [Words] AND Pediatrics [Words] AND COVID-19 [Words] AND Pediatrics [Words] AND SARS-CoV-2 [Words]
SciELO**	((Infant, Newborn) AND (coronavirus)) AND ((Infant, Newborn) AND (COVID-19)) AND ((Infant, Newborn) AND (SARS-CoV-2)) AND ((Pediatrics) AND (coronavirus)) AND ((Pediatrics) AND (COVID-19)) AND ((Pediatrics) AND (SARS-CoV-2))
Catalog of Theses and Dissertations (CAPES)††	("Infant, Newborn" AND "Coronavirus") AND ("Infant, Newborn" AND "COVID-19") AND ("Infant, Newborn" AND "SARS-CoV-2") AND ("Pediatrics" AND "Coronavirus") AND ("Pediatrics" AND "COVID-19") AND ("Pediatrics" AND "SARS-CoV-2")

Reference/Year of publication/Country	Population	Type of Study/Level of evidence/Degree of recommendation
Chen et al⁽¹⁵15 Chen ZM, Fu JF, Shu Q, Chen YH, Hua CZ, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;1-7. doi: 10.1007/s12519-020-00345-5 https://doi.org/10.1007/s12519-020-00345... ⁾./2020/China.	Pediatric patients.	Ecological/2C/B.
Hong et al⁽⁵5 Hong H, Wang Y, Chung H, Chen C. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. PEDN. 2020;61(2)131-2. doi: 10.1016/j.pedneo.2020.03.001 https://doi.org/10.1016/j.pedneo.2020.03... ⁾ ./2020/Netherlands	NBs, infants and children.	Ecological/2C/B.
Ji et al⁽²⁰20 Ji LN, Chao S, Wang YJ, Li XJ, Mu XD, Lin MG, et al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World J Pediatr. 2020; 1-4. doi: 10.1007/s12519-020-00356-2 https://doi.org/10.1007/s12519-020-00356... ⁾./2020/China	Two pediatric patients (1st with 15 years old and 2nd with 9 years old).	Retrospective/3A/B.
Chen et al⁽²¹21 Chen J, Zhang ZZ, Chen YK, Long QX, Tian WG, Deng HJ, et al. The clinical and immunological features of pediatric COVID-19 patients in China. Genes Dis. 2020;1-7. doi: 10.1016/j.gendis.2020.03.008 https://doi.org/10.1016/j.gendis.2020.03... ⁾./2020/China	12 pediatric patients (7 months to 17 years).	Retrospective/3A/B.
Qiu et al⁽²²22 Qui H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;1-8. doi: 10.1016/S1473-3099(20)30198-5 https://doi.org/10.1016/S1473-3099(20)30... ⁾./2020/United States of America	36 pediatric patients (0 to 16 years).	Observational cohort/2B/B.
Schwartz et al⁽²³23 Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):1-16. doi: 10.3390/v12020194 https://doi.org/10.3390/v12020194... ⁾./2020/Switzerland	One NB.	Ecological/2C/B.
Shen et al⁽²⁴24 Shen KL, Yang YH. Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue. World J Pediatr. 2020;1-3. doi: 10.1007/s12519-020-00344-6 https://doi.org/10.1007/s12519-020-00344... ⁾./2020/China	28 pediatric patients.	Editorial/5/D.
Sun et al⁽²⁵25 Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study. World J Pediatr. 2020;1-9. doi: 10.1007/s12519-020-00354-4 https://doi.org/10.1007/s12519-020-00354... ⁾./2020/China	Eight severely ill or seriously ill pediatric patients.	Cohort/2B/B.
Xia et al⁽²⁶26 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol. 2020;55(5):1-6. doi: 10.1002/ppul.24718 https://doi.org/10.1002/ppul.24718... ⁾./2020/United States of America	20 pediatric patients.	Retrospective/3A/B.
Zhu et al⁽²⁷27 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60. doi: 10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06... ⁾./2020/China	10 NBs of mothers infected by 2019-nCoV.	Retrospective/3A/B.

Reference	Clinical findings	Treatment	Outcome
¹⁵15 Chen ZM, Fu JF, Shu Q, Chen YH, Hua CZ, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;1-7. doi: 10.1007/s12519-020-00345-5 https://doi.org/10.1007/s12519-020-00345...	Fever, fatigue, cough, nasal congestion, runny nose, sputum, diarrhea, headache, dyspnea, cyanosis, malaise or restlessness, poor diet, poor appetite and less activity. Decreased lymphocyte count; increased C-Reactive Protein (CRP). Multiple bilateral ground-glass opacity, infiltrating shadows and pulmonary consolidation.	Social isolation, adequate rest, nutrition and hydration, antiviral therapy (nebulization with interferon; lopinavir/ritonavir), antibiotics, immunomodulatory therapy (in severe cases), respiratory support.	No deaths reported in the study. Pediatric patients had good prognosis.
⁵5 Hong H, Wang Y, Chung H, Chen C. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. PEDN. 2020;61(2)131-2. doi: 10.1016/j.pedneo.2020.03.001 https://doi.org/10.1016/j.pedneo.2020.03...	Fever, dry cough, fatigue, nasal congestion, runny nose, abdominal discomfort, nausea, vomiting, abdominal pain, and diarrhea.	In NBs, suspected and confirmed cases should be admitted to a neonatal ICU. Treatment with antivirals; if respiratory distress syndrome, administer pulmonary surfactant, inhalation of nitric oxide and high-frequency oscillatory ventilation. In severe NBs, intravenous administration of glucocorticoids or immunoglobulins and sustainable renal replacement can be considered.	Absent.
²⁰20 Ji LN, Chao S, Wang YJ, Li XJ, Mu XD, Lin MG, et al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World J Pediatr. 2020; 1-4. doi: 10.1007/s12519-020-00356-2 https://doi.org/10.1007/s12519-020-00356...	Fever, pharyngeal congestion and diarrhea. High white blood cell count, high PCR.	In the 1st patient, symptomatic treatment was used (study does not describe treatment). In the 2nd patient, an oral probiotic was administered and the symptoms disappeared after two days of treatment.	Patients were cured without sequel.
²¹21 Chen J, Zhang ZZ, Chen YK, Long QX, Tian WG, Deng HJ, et al. The clinical and immunological features of pediatric COVID-19 patients in China. Genes Dis. 2020;1-7. doi: 10.1016/j.gendis.2020.03.008 https://doi.org/10.1016/j.gendis.2020.03...	Fever, cough, diarrhea, sore throat, nasal pain, dizziness, fatigue. Leukopenia, lymphopenia, elevated CRP, higher amount of T lymphocytes. Bilateral ground-glass opacities, irregular lung shading.	Treatment with antiviral drugs. Inhalation therapy for interferon-α 1b, Lopinavir/Ritonavir, Ribavirin.	All patients relieve the symptom 3 to 4 days after admission to the hospital. No case progressed to severe.
²²22 Qui H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;1-8. doi: 10.1016/S1473-3099(20)30198-5 https://doi.org/10.1016/S1473-3099(20)30...	Common symptoms: fever (36%), dry cough (19%), dyspnea or tachypnea (3%), pharyngeal congestion (3%), sore throat (6%), vomiting or diarrhea (6%), headache. 30% had pneumonia + cough. 53% with pulmonary opacity (ground glass) on computed tomography (CT). Elevation of MB creatine kinase (31%), decrease of lymphocytes (31%), leukopenia (19%) and elevated procalcitonin.	Upon admission, all children were treated with alpha interferon by aerosolization twice daily, 14 (39%) received lopinavir-ritonavir syrup twice daily and six (17%) required oxygen inhalation.	All 36 patients were cured and discharged.
²³23 Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):1-16. doi: 10.3390/v12020194 https://doi.org/10.3390/v12020194...	Breathlessness, liver function and abnormal chest X-rays.	Treatment not described in the study.	Absent.
²⁴24 Shen KL, Yang YH. Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue. World J Pediatr. 2020;1-3. doi: 10.1007/s12519-020-00344-6 https://doi.org/10.1007/s12519-020-00344...	Fever, fatigue, dry cough, nasal congestion and runny nose are reported as the most common symptoms. Although, less common, nausea, vomiting and diarrhea can be mentioned. Normal or slightly elevated PCR. Chest x-ray suggestive of pneumonia.	Alpha interferon atomization can be considered as a treatment option for 2019-nCoV pneumonia. The safety and effectiveness of using interferon still needs confirmation.	Patients with mild symptoms recovered within 1-2 weeks. Few patients developed lower respiratory tract infection.
²⁵25 Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study. World J Pediatr. 2020;1-9. doi: 10.1007/s12519-020-00354-4 https://doi.org/10.1007/s12519-020-00354...	Polypnea, fever, cough, sputum, nausea/vomiting, diarrhea, fatigue/myalgia, headache, constipation, unilateral or bilateral pneumonia, are more common symptoms. Adhesive shadows, ground-glass opacity, pleural effusion, and white alteration of the lung were also present in the alterations of image exams. CRP, procalcitonin and lactate dehydrogenase increased in more than half of patients. Main complications were septic shock and multiple organ dysfunction syndrome. Toxic encephalopathy, disseminated intravascular coagulation, hydronephrosis, heart failure, among others, have also been reported.	Symptomatic treatment and respiratory support. Most patients received high flow oxygen therapy, two received mechanical ventilation, all received antiviral treatment with virazole, oseltamivir and interferon. Antibiotics, traditional Chinese medicine, intravenous glucocorticoids and immunoglobulin have also been used in some cases.	5 cures with hospital discharge and 3 remained hospitalized in ICUs.
²⁶26 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol. 2020;55(5):1-6. doi: 10.1002/ppul.24718 https://doi.org/10.1002/ppul.24718...	Fever above 37.3°C, cough, diarrhea, nasal discharge, vomiting, tachypnea, sore throat, fatigue, wet crackles and signs of retraction were observed. Uni or bilateral pulmonary lesions, subpleural lesions with localized inflammatory infiltration, consolidation with surrounding halo, ground-glass opacity, fine mesh shade and small nodules. Increase in procalcitonin in 80% of cases and creatine kinase-MB in 75%.	All patients were treated, but the study does not specify the treatment.	18 cures with hospital discharge and two remained hospitalized under observation.
²⁷27 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60. doi: 10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06...	Shortness of breath (main symptom), fever, tachycardia, vomiting, food intolerance, bloating, refusal of milk, gastric bleeding and neonatal respiratory distress syndrome, infections. Abnormal chest radiography. Complicated thrombocytopenia with abnormal liver function, refractory shock, multiple organ failure, disseminated intravascular coagulation and falling platelets.	Symptomatic supportive treatment; intravenous infusion of suspended red blood cells, platelets and plasma; respiratory support, intravenous infusion of gamma globulin, platelet transfusion, plasma, use of hydrocortisone, low-dose sodium heparin associated with low molecular weight heparin calcium.	5 cures with hospital discharge, 1 death and 4 remained hospitalized.

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[1] Corresponding author: Daniele Vieira Dantas E-mail: daniele00@hotmail.com