Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Preparedness for an Isolation Unit during Covid‐19 Pandemic in PICU of Minia University Hospital: Practical Considerations and Outcomes

Document Type : original article

Authors
Nagwa Mohamed Sabry Mahmoud 1
Suzan Omar Mousa 2
Reham Ali Ibrahem 3
Walid A. M. Omara 3
Ahlam M. Ismail 4
1 Assistant Professor of Pediatrics, Pediatric Department, Faculty of Medicine, Minia University, Egypt
2 Assistant professor of Pediatric, Pediatric Department, Faculty of Medicine, Minia University, Egypt
3 Assistant professor of Microbiology and immunology, Microbiology and immunology department faculty of pharmacy, Minia University, Egypt
4 Professor of Pediatrics, Pediatric Department, Faculty of Medicine, Minia University, Egypt
10.22038/ijp.2023.68671.5092
Abstract
Background: Admission to the pediatric intensive care unit (PICU) is compulsory for children with a severely complicated form of COVID-19, who are hemodynamically unstable. Our study determined the degree to which our PICU preparedness measures impacted patient outcomes and infection control management within the PICU of Minia University Hospital in Egypt.
Methods: 179 pediatric patients, admitted to the PICU isolation unit with suspected or confirmed diagnosis of COVID-19, were studied retrospectively. We conducted descriptive analyses on the patients' characteristics and outcomes and the basic concepts and procedures for PICU readiness are discussed.
Results: The patients ranged in age from one month to sixteen years, with an average age of 8.60±4.84 years, 44.69 % of whom were males. Fever, shortness of breath, and cough were the most common symptoms on admission. The most common comorbidities were neurological disorders, heart disease, and respiratory disease, with percentages of 27 %, 25 %, and 23 %, respectively. Overall, mortality was 22.9 %. Only 21 (0.5%) of the hospital's healthcare staff were infected. The infection did not spread to other non-COVID parts of the hospital.
Conclusion: Our PICU strategies and preparation ensured adequate prevention of infection spreading to other units and HWCs, as well as lowering mortality and improving COVID-19 patients’ outcomes.
Keywords
PICU,,
,،Covid19,,
,،strategies,,
,،preparedness
  1. World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. http://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020 (Accessed on February 12, 2020).
  2. Gorbalenya AE, Baker SC, Baric RS, Groot RJd, Drosten C, Gulyaeva AA, Haagmans BL, Lauber C, Leontovich AM, Neuman BW, Penzar D, Perlman S, Poon LLM, Samborskiy D, Sidorov IA, Sola I, Ziebuhr J. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group. bioRxiv 2020. https://www.biorxiv.org/content/10.1101/2020.02.07.937862v1 (Accessed on February 12, 2020).
  3. World Health Organization (WHO). WHO Director-General's opening remarks at the media briefing on COVID-19- 11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (Accessed on May 01, 2020).
  4. Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward J, Hudson L, Waddington C, Thomas J, Russell S, Klis Fvd, Koirala A, Ladhani S, Panovska-Griffiths J, Davies NG, Booy R, Eggo RM. Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. JAMA Pediatr. 2021; 175(2):143–56. https://doi.org/10.1001/jamapediatrics.2020.4573.
  5. Cusenza F, Davino G, D'Alvano T, Argentiero A, Fainardi V, Pisi G, Principi N, Esposito S. Silence of the lambs: the immunological and molecular mechanisms of COVID-19 in children in comparison with adults. Microorganisms. 2021; 9(2):330. https://doi.org/10.3390/microorganisms9020330.
  6. Li F, Li YY, Liu MJ, Fang LQ, Dean NE, Wong GWK, Yang XB, Longini I, Halloran ME, Wang HJ, Liu PL, Pang YH, Yan YQ, Liu S, Xia W, Lu X, Liu Q, Yang Y, Xu SQ. Household transmission of SARS-CoV-2 and risk factors for susceptibility and infectivity in Wuhan: a retrospective observational study. Lancet Infect Dis. 2021; S1473–3099(20):30981–6.
  7. Vergine G, Fantini M, Marchetti F, Stella M, Valletta E, Biasucci G, Lanari M, Dodi I, Bigi M, Magista AM, Vaienti F, Cella A, Affanni P, Carla M, Sambri V, Esposito S, The Regione Emilia-Romagna COVID-19 Pediatric Working Group (RERCOPed). Home management of children with COVID-19 in the Emilia-Romagna Region, Italy. Front Pediatr. 2020; 8:575290.
  8. American Academy of Pediatrics. Children and COVID-19: state-level data report. Available at: https://downloads.aap.org/AAP/PDF/AAP%20and%20CHA%20-%20Children%20and%20COVID-19%20State%20Data%20Report%201.28.21%20FINAL.pdf Accessed 4 Feb 2021.
  9. Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, Gabrovska N, Velizarova S, Prunk P, Osterman V, Krivec U, Vecchio AL, Shingadia D, Soriano-Arandes A, Melendo S, Lanari M, Pierantoni L, Wagner N, L'Huillier AG, Heininger U, Ritz N, Bandi S, Krajcar N, Roglić S, Santos M, Christiaens C, Creuven M, Buonsenso D, Welch SB, Bogyi M, Brinkmann F, Tebruegge M, ptbnet COVID-19 Study Group. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020; 4(9):653–61. https://doi.org/10.1016/S2352-4642(20)30177-2.
  10. Garazzino S, Lo Vecchio A, Pierantoni L, Calò Carducci FI, Marchetti F, Meini A, Castagnola E, Vergine G, Donà D, Bosis S, Dodi I, Venturini E, Felici E, Giacchero R, Denina M, Pierri L, Nicolini G, Montagnani C, Krzysztofiak A, Bianchini S, Marabotto C, Tovo PA, Pruccoli G, Lanari M, Villani A, Gattinara GC; Italian SITIP-SIP Pediatric Infection Study Group. Epidemiology, clinical features and prognostic factors of pediatric SARS-CoV-2 infection: results from an Italian multicenter study. Front Pediatr. 2021; 9:649358.
  11. Esposito S, Marchetti F, Lanari M, Caramelli F, De Fanti A, Vergine G, Iughetti L, Fornaro M, Suppiej A, Zona S, Pession A, Biasucci G; Working Group on COVID-19 in Pediatrics of the Emilia-Romagna Region (RE-CO-Ped). COVID-19 Management in the Pediatric age: consensus document of the COVID-19 working Group in Paediatric sof the Emilia-Romagna region (RE-CO-Ped), Italy. Intern J environ res. Public Health. 2021; 18:8.
  12. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F, Brierley J, McDougall M, Carter M, Tremoulet A, Shimizu C, Herberg J, Burns JC, Lyall H, Levin H; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020; 324:259.
  13. Centers for Disease Control and Prevention. Information for healthcare professionals about coronavirus (COVID-19). https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html (Accessed on October 06, 2020).
  14. World Health Organization. Clinical management of COVID-19 interim guidance. May 27, 2020. Available at: https://www.who.int/publications/i/item/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected (Accessed on July 16, 2020).
  15. Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html (Accessed on February 14, 2020).
  16. World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance (Accessed on February 14, 2020).
  17. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 among Children in China. Pediatrics 2020; 145.
  18. Lu X, Zhang L, Du H, et al. SARS-CoV-2 Infection in Children. N Engl J Med 2020; 382:1663.
  19. Amin Abdel Baki's, Hossam Hosny Masoud, Gehan Elassal, Samy Zaky, Ehab Kam, Wagdya Amin, Akram Abdelbary et al . Management Protocol for COVID-19 Patients Version 1.4/30th May 2020 Ministry of health and population (MOHP), Egypt. May 2020 in book: Coronavirus Disease 2019 (COVID-19), SARS COV2 Management Guideline Publisher: Ministry of Health and Population, https://www.researchgate.net/publication/344078546 http://www.mohp.gov.eg/JobsDetails.aspx?job_id=3061.
  20. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020.
  21. WHO [Internet]. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases; [cited 2021. February 16] Available from: https://apps.who.int/iris/bitstream/handle/10665/331329/WHO-COVID-19-laboratory-2020.4-eng.pdf?sequence=1&isAllowed=y.
  22. Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S, Adriano A, Beese S, Dretzke J, Ruffano LFd, Harris IM, Price MJ, Dittrich S, Emperador D, Hooft L, Leeflang MM, Bruel AVd, Cochrane COVID-19 Diagnostic Test Accuracy Group. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev. 2020. June. [PMC free article] [PubMed] [Google Scholar].
  23. Watson J, Whiting PF, Brush JE. Interpreting a covid-19 test result. BMJ. 2020; 369:m1808. [PubMed] [Google Scholar].
  24. Wikramaratna PS, Paton RS, Ghafari M, Lourenço J. Estimating the false-negative test probability of SARS-CoV-2 by RT-PCR. Euro Surveill. 2020; 25(50):2000568. [PMC free article] [PubMed] [Google Scholar].
  25. Pokorska-Śpiewak M, Talarek E, Popielska J, Nowicka K, Ołdakowska A, Zawadka K, Kowalik-Mikołajewska B, Tomasik A, Dobrzeniecka A, Lipińska M, Krynicka-Czech B, Coupland U, Stańska-Perka A, Ludek M, Marczyńska M. Comparison of clinical severity and epidemiological spectrum between coronavirus disease 2019 and influenza in children. Sci Rep. 2021; 11(1):5760.
  26. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, Heidemann SM, Kleinman LC, Sen AI, Hall MW, Priestley MA, McGuire JK, Boukas K, Sharron MP, Burns JP; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020; 174(9):86873. https://doi.org/10.1001/jamapediatrics.2020.1948.
  27. Ogimi C, Englund JA, Bradford MC, Qin X, Boeckh M, Waghmare A. Characteristics and outcomes of coronavirus infection in children: the role of viral factors and an immunocompromised state. J Pediatric Infect Dis Soc. 2019; 8(1):21–8.
  28. Carcillo JA, Sward K, Halstead ES, Telford R, Jimenez-Bacardi A, Shakoory B, Simon D, Hall M; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators. A systemic inflammation mortality risk assessment contingency table for severe sepsis. Pediatr Crit Care Med. 2017; 18(2):143–50.
  29. Zachariah P, Johnson CL, Halabi KC, Ahn D, Sen AI, Fischer A, Banker SL, Giordano M, Manice CS, Diamond R, Sewell TB, Schweickert AJ, Babineau JR, Carter RC, Fenster DB, Orange JS, McCann TA, Kernie SG, Saiman L, Columbia Pediatric COVID-19 Management Group. Epidemiology, clinical features, and disease severity in patients with Coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York. JAMA Pediatr. 2020; 174(10):e202430. https://doi.org/10.1001/jamapediatrics.2020.2430.
  30. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5):846–8. https://doi.org/10.1007/s00134-020-05991-x.
  31. Dong, Y. Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 among Children in China. Pediatrics145, e20200702 (2020).
  32. Parri, N., Lenge, M. & Buonsenso, D. Children with Covid-19 in pediatric emergency departments in Italy. N. Engl. J. Med. 383, 187–190 (2020).
  33. Swann, O. V. Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, Seth S, Egan C, Hardwick HE, Halpin S, Girvan M, Donohue C, Pritchard M, Patel LB, Ladhani S, Sigfrid L, Sinha IP, Olliaro PL, Nguyen-Van-Tam JS, Horby PW, Merson L, Carson G, Dunning J, Openshaw PJM, Baillie JK, Harrison EM, Docherty AB, Semple MG; ISARIC4C Investigators. Clinical characteristics of children and young people admitted to hospital with covid-19 in the United Kingdom: prospective multicentre observational cohort study. Bmj 370, m3249 (2020).

 

Journal of Pediatric Perspectives
Volume 11, Issue 4
April 2023
Pages 17544-17557