Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

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OBJECTIVE

To assess the effectiveness of clinical guidelines in the treatment of severe forms of a new coronavirus infection in children.

MATERIAL AND METHODS

A retrospective controlled non-randomized multiple-center study enrolled 111 ICU children from 40 hospitals. Specialists of the Federal Remote Intensive Care Counselling Centre counseled all patients. Children were divided into 2 groups («recovery» and «death») depending on the outcome.

RESULTS

PSOFA score 2 (1—5) at admission was associated with 19.5-fold increase of mortality risk (OR 19.5, 95% CI 2.3—165.7). We found higher score «respiratory distress» item in all patients regardless the outcome. Antibacterial, corticosteroid therapy and vasopressor support significantly affected the outcome of disease (χ²=18.202; df=3, p=0.000), while infusion, respiratory, anticoagulant therapy and enteral nutrition were less significant, especially in pSOFA score ≤4 points (χ²=15.521; df=5, p=0.008). Mortality risk decreased in no need for increase of initial doses of catecholamines (OR 0.2, 95% CI=0.1—0.7). Less compliance with recommendations for correction of antibacterial and corticosteroid therapy was followed by higher mortality (OR 5.2, 95% CI 1.4—18.9 and OR 3.4, 95% CI 1.1—10.8, respectively).

CONCLUSION

Timely strict implementation of clinical guidelines, adequate catecholamine support, antibacterial and corticosteroid therapy in children with COVID-19 significantly reduce the likelihood of mortality.

Keywords:

new coronavirus infection

intensive care

efficacy

pSOFA

outcome

children

Authors:

Prometnoy D.V.

Russian Children’s Clinical Hospital of the Pirogov Russian National Research Medical University

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Mironov P.I.

Bashkir State Medical University

ORCID: 0000-0002-9016-9461

Pshenisnov K.V.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Anchutin P.E.

Pirogov Russian National Research Medical University

Ivanilova A.A.

Saint-Petersburg State Pediatric Medical University

Received:

01.01.2022

Accepted:

08.02.2022

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