УДК:616.9:578.834.1--038.83-053.2
FEATURES OF THE REHABILITATION OF CHILDREN WITH COVID-19
Turdikul Akramovich BOBOMURATOV1, Dilnoza Jamolovna SHARIPOVA2,
Nafisa Sobirovna SULTANOVA3
1professor, Tashkent Medical Academy
2Tashkent Medical Academy
3Tashkent Medical Academy
ОСОБЕННОСТИ РЕАБИЛИТАЦИИ ДЕТЕЙ С COVID-19
Турдикул Акрамович БОБОМУРАТОВ1, Дилноза Жамоловна ШАРИПОВА2,
Нафиса Собировна СУЛТАНОВА3
1профессор, Ташкентская медицинская академия
2Ташкентская медицинская академия
3Ташкентская медицинская академия
COVID-19 БЎЛГАН БОЛАЛАРНИ РЕАБИЛИТАЦИЯ ҚИЛИШНИНГ ЎЗИГА ХОСЛИГИ
Турдиқул Акрамович БОБОМУРАТОВ1, Дилноза Жамоловна ШАРИПОВА2,
Нафиса Собировна СУЛТАНОВА3
1профессор, Тошкент тиббиёт академияси
2Тошкент тиббиёт академияси
3Тошкент тиббиёт академияси
ABSTRACT
The aim of the review was to identify the features of the clinical course of the disease in children who have undergone coronavirus infection. The review showed that coronavirus disease in children is frequent and severe, which requires individual care and careful diagnosis.
Key words: coronavirus infection, diagnostics, children, pneumonia, respiratory tract, rehabilitation, markers.
АННОТАЦИЯ
Целью обзора явилось выявление особенностей клинического течения заболевания у детей, перенёсших короновирусную инфекцию. Обзор показал, что заболевание короновирусом у детей встречается часто и протекает в тяжёлой форме, что требует индувидуального ухода и тщательной диагностики.
Ключевые слова: короновирусная инфекция, диагностика, дети, пневмония, респираторный тракт, реабилитация, маркеры.
АННОТАЦИЯ
Шарҳнинг мақсади короновирус инфекциясига чалинган болаларда касалликнинг клиник кечиш хусусиятларини аниқлаш ҳисобланди. Шарҳ шуни кўрсатдики, болаларда короновирус касаллиги кенг тарқалган бўлиб, оғир ўтади ҳамда бу индивидуал парвариш ва эҳтиёткорлик билан ташхислашни талаб қилади.
Калит сўзлар: короновирус инфекцияси, ташхислаш, болалар, пневмония, нафас олиш йўллари, реабилитация, маркерлар.
Introduction. Coronavirus infection is a disease that affects mammals and birds with a strict species identity. In humans, the infection proceeds as an acute disease of the respiratory tract with a polymorphic clinical picture - from mild catarrh of the upper respiratory tract to severe lesions of the lower respiratory tract with high mortality. The new coronavirus was identified in early January 2020, initially dubbed 2019-nCoV. Currently SARS-CoV-2 is classified as a new beta-coronavirus, lineage B (Sarbecovirus subgenus), which also includes the SARS-CoV virus that caused SARS (Severe Acute Respiratory Syndrome) in 2002-2003 [1,3,4,14].
State-level reports are the best publicly available and timely data on child COVID-19 cases in the United States. The American Academy of Pediatrics and the Children’s Hospital Association are collaborating to collect and share all publicly available data from states on child COVID-19 cases. The definition of “child” case is based on varying age ranges reported across states (see report Appendix for details and links to all data sources) [7, 8].
Reported COVID-19 cases among children have spiked dramatically in 2022 during the Omicron variant surge, almost 4.2 million child cases were reported since the beginning of January. For the week ending February 3rd, nearly 632,000 additional child COVID-19 cases were reported, down from the peak level of 1,150,000 reported the week ending January 20th. However, child cases this week remained extremely high, over double the peak level of the Delta surge in 2021 [13, 14].
Over 12 million children have tested positive for COVID-19 since the onset of the pandemic; over 1,4 million of these cases have been added in the past 2 weeks. For the 26th week in a row child COVID-19 cases are above 100,000. Since the first week of September, there have been nearly 7 million additional child cases [14].
The age distribution of reported COVID-19 cases was provided on the health department websites of 49 states, New York City, the District of Columbia, Puerto Rico, and Guam. Since the pandemic began, children represented 18,9% of total cumulated cases. For the week ending February 3, children were 25,0% of reported weekly COVID-19 cases (children, under age 18, make up 22,2% of the US population). A smaller subset of states reported on hospitalizations and mortality by age. There is an urgent need to collect more age-specific data to assess the severity of illness related to new variants as well as potential longer-term effects. It is important to recognize there are immediate effects of the pandemic on children’s health, but importantly we need to identify and address the long-lasting impacts on the physical, mental, and social well-being of this generation of children and youth [14].
It is believed that the virus enters the cell by attaching angiotensin converting enzyme 2 (ACE2) to the receptors using the surface S (spike) protein. Once infected, the virus spreads through the mucus through the respiratory tract, causing a significant release of cytokines and an immune response in the body. At the same time, there is a decrease in the number of lymphocytes in the blood, in particular T-lymphocytes. The duration of immunity after suffering a disease has not yet been established [5,7,13].
The purpose of this review was to study various methods of rehabilitation for children with COVID-19.
The material for this review was 25 scientific publications from the PubMed database over the past 3 years, dedicated to the methods of rehabilitation of children with COVID-19.
Results and its discussion. The source of infection is a person, the possibility of transmission of infection from an animal and vice versa has not been confirmed. Available evidence suggests that the patient is most contagious during the first seven days after the onset of symptoms. At the same time, the possibility of virus transmission both in the incubation period and in the period of convalescence is not excluded, but the infectivity is probably lower [4,8]. In addition, prolonged excretion of the virus in the feces allows the possibility of a fecal-oral transmission mechanism, although some authors currently do not consider this mechanism as the main one in the transmission of infection from person to person [10,12,15].
The susceptibility of the child population. Children are as susceptible to COVID-19 as adults. But the reasons for the milder course of infection in children remain unclear, and there are many hypotheses that require further research. Given the high proportion of asymptomatic and mild forms, children are now considered potential sources of infection. At the same time, testing of the child population in the outbreaks does not confirm their high infection rate, and the main infection of children occurs in family outbreaks or medical institutions (maternity hospitals) [2,7,10]. Currently, COVID-19 is considered an acute respiratory viral infection with a predominant effect on the lower respiratory tract. The disease can occur in the form of mild ARVI or have a severe course with the development of pneumonia, ARDS and sepsis. In severe forms, respiratory failure reaches its maximum severity by 6-8 days of illness. Known cases of coronavirus infection in children caused by SARS-CoV-2 do not allow an objective assessment of the features of the disease, as well as characteristic manifestations at all stages of the disease. Compared with adults, diarrheal syndrome is more often observed in children [1,8,10]. At the same time, the authors note that a high percentage of more severe forms in young and young children in this sample may be due to the fact that the study included children whose diagnosis of COVID-19 was established without laboratory confirmation, thereby not excluding other etiology of infection, including RSV [4,5,6]. A small number of children infected with SARS-CoV-2 may be associated with a possible low risk of contracting the virus or the development of mild or asymptomatic diseases that cannot be fully identified, but the presence of comorbidities can aggravate the course of COVID-19 [3,4].
In addition, even in the absence of typical complaints, changes in the lungs characteristic of coronavirus pneumonia can be found in children. In this regard, it is necessary to visualize the lungs even in the absence of physical signs of pneumonia, as well as to isolate and examine children with mild forms and contact without symptoms of the disease, due to the fact that they can be sources of infection. Children under one year old are susceptible to infection, infection usually occurs through intrafamilial contact, at present, severe forms of the disease are more often detected in children under 1 year of age.
As the studies show, the clinical manifestations of lower respiratory tract damage in children are not pronounced and nonspecific. None of the studies described auscultatory changes, and therefore the signs of an inflammatory pulmonary process can be a combination of cough, fever, shortness of breath and decreased oxygen saturation [7, 11, 13]. The presence of all four symptoms suggests a severe course of COVID-19 and is an indication for an emergency chest CT scan. At the same time, changes on CT can be noted in children with mild and asymptomatic forms, but the same changes may not be visualized on plain radiography, and therefore chest CT is the preferred method for imaging.
WHO currently recommends the following diagnostic characteristics for non-severe pneumonia and severe pneumonia in children with COVID-19 [9,10,11,15].
To date, there are no scientific publications on the features of ARDS against the background of COVID-19 in children, however, with a high degree of probability, ARDS could cause the death of adolescents 12-16 years old. There is evidence of the development of distress syndrome in a newborn child born at 32 weeks from a sick mother. The specific symptoms of ARDS are determined on X-ray examination, but more clearly and specifically on CT of the lungs. The next step, based on the specific CT picture, is to determine the severity of the child's condition. For this, the oxygenation index is used with the use of PaO2 in the calculation of the oxygen tension in arterial blood to calculate the OI index or blood saturation SpO2 (OSI). The definitions of ARDS from the 2015 Pediatric Respiratory Distress Syndrome Consensus Conference are used to determine the severity of ARDS that occurs in children as a complication of COVID-19. Definition of ARDS in children, taking into account the current WHO recommendations (Consensus Conference on Pediatric Respiratory Distress Syndrome, 2015). Additionally, WHO recommends an objective assessment (for example, ECHO-KG) to exclude a hydrostatic cause of infiltrates / edema, if there are no risk factors.
One of the severe extrapulmonary complications requiring intensive care is sepsis and septic shock. A suspected or proven infection and two or more SIRS criteria, of which an abnormal body temperature or a change in the number of leukocytes, will indicate the course of the septic process. Sepsis and septic shock is regarded as a critical form of COVID-19 [1,7,9,14].
Conclusion. Considering the above, the management and treatment of children with coronavirus requires an individual approach and rehabilitation should be necessary to restore the body's vital functions.
