Severe pediatric COVID-19:a review from the clinical and immunopathophysiological perspectives

Yi-Kan Sun ¹Can Wang ²Pei-Quan Lin ²Lei Hu ²Jing Ye ²Zhi-Gang Gao ³Ru Lin ⁴Hao-Min Li ⁵Qiang Shu ⁶Li-Su Huang ⁷Lin-Hua Tan²

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作者信息

1. Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310030,China
2. Surgical Intensive Care Unit,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
3. Department of General Surgery,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
4. Department of Cardiopulmonary and Extracorporeal Life Support,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
5. Clinical Data Center,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
6. Department of Cardiac Surgery,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;National Clinical Research Center for Child Health,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
7. National Clinical Research Center for Child Health,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Infectious Diseases,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China
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Abstract

Background Coronavirus disease 2019(COVID-19)tends to have mild presentations in children.However,severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times,meriting further atten-tion from clinicians.Meanwhile,the intricate interactions between the pathogen virulence factors and host defense mecha-nisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.Data sources A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed,Embase,and Wanfang databases.Searched keywords included"COVID-19 in children","severe pediatric COVID-19",and"critical illness in children with COVID-19".Results Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvac-cinated status.Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations,while various forms of cardiovascular and neurological involvement may also be seen.Multiple immunological processes are implicated in the host response to COVID-19 including the type Ⅰ interferon and inflammasome pathways,whose dysregu-lation in severe and critical diseases translates into adverse clinical manifestations.Multisystem inflammatory syndrome in children(MIS-C),a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure,denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity.Despite the considerable dissimilarities between the pediatric and adult immune systems,clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.Conclusions Severe pediatric COVID-19 can affect multiple organ systems.The dysregulated immune pathways in severe COVID-19 shape the disease course,epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults.Consequently,further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.

Key words

Immunopathophysiology/MIS-C/Pediatric critical care/Severe pediatric COVID-19

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基金项目

Key Research and Development Program of Zhejiang(2023C03029)

出版年

2024

世界儿科杂志(英文版)

CSTPCD

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参考文献量236

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