Clinical evolution of cases of COVID-19 infection in neopediatrics: a 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

doi:10.1590/0034-7167-2020-0662

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

Clinical evolution of cases of COVID-19 infection in neopediatrics: a scoping review

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective to map the knowledge about the clinical findings, treatment and outcome of newborns and children infected with COVID-19.

Methods a scoping review with search of eight databases and electronic search engine in April 2020.

Results the 12 studies analyzed showed that the main clinical findings in this population were nasal congestion, fever, respiratory distress, diarrhea, fatigue, dry cough, increased C-reactive protein, leukopenia, lymphopenia, thrombocytopenia, elevated procalcitonin, bilateral ground-glass opacity, pulmonary consolidation, and pneumonia. Antivirals, respiratory support, immunomodulatory therapy, glucocorticoids, antibiotics and alpha interferon were used as treatment. The presence of a cure with hospital discharge is present in most cases.

Final considerations most patients required hospitalization, but it evolved to cure. This study provided a greater scientific basis by showing clinical findings, treatment, and outcomes in neopediatric patients with COVID-19.

Descriptors:
Coronavirus; Newborn; Pediatrics; Clinical Evolution; Infections

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⁽¹⁵⁾./2020/China.	Pediatric patients.	Ecological/2C/B.
Hong et al⁽⁵⁾ ./2020/Netherlands	NBs, infants and children.	Ecological/2C/B.
Ji et al⁽²⁰⁾./2020/China	Two pediatric patients (1st with 15 years old and 2nd with 9 years old).	Retrospective/3A/B.
Chen et al⁽²¹⁾./2020/China	12 pediatric patients (7 months to 17 years).	Retrospective/3A/B.
Qiu et al⁽²²⁾./2020/United States of America	36 pediatric patients (0 to 16 years).	Observational cohort/2B/B.
Schwartz et al⁽²³⁾./2020/Switzerland	One NB.	Ecological/2C/B.
Shen et al⁽²⁴⁾./2020/China	28 pediatric patients.	Editorial/5/D.
Sun et al⁽²⁵⁾./2020/China	Eight severely ill or seriously ill pediatric patients.	Cohort/2B/B.
Xia et al⁽²⁶⁾./2020/United States of America	20 pediatric patients.	Retrospective/3A/B.
Zhu et al⁽²⁷⁾./2020/China	10 NBs of mothers infected by 2019-nCoV.	Retrospective/3A/B.

Reference	Clinical findings	Treatment	Outcome
¹⁵	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.
⁵	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.
²⁰	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.
²¹	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.
²²	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.
²³	Breathlessness, liver function and abnormal chest X-rays.	Treatment not described in the study.	Absent.
²⁴	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.
²⁵	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.
²⁶	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.
²⁷	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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[TFN1] Note: *MEDLINE - Medical Literature Analysis and Retrieval System Online; † Scopus - Elsevier's SCOPUS; ‡ CINAHL - Cumulative Index of Nursing and Allied Health; §Web of Science; ||Cochrane Library; ¶LILACS - Latin American & Caribbean Literature in Health Sciences; **SciELO - The Scientific Electronic Library Online; †† Catalog of Theses and Dissertations (CAPES)