Pediatrics
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491
Table 2. Features of Kawasaki Disease and pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 artery disease when administered within 10 days of onset of fever. In addition, acetylsalicylic acid, glucocorticoids and anti-TNF monoclonal antibodies have been used
Prognosis
treatment is common (Verdoni 2020,) Management on the pediatric intensive care unit is often necessary: progression to vasoplegic shock is common Hemodynamic support, treatment with noradrenaline and milrinone, mechanical ventilation is often required (Riphagen 2020)
Self-limited vasculitis lasting Overall prognosis not yet clear for an average of 12 days More severe course than KD without therapy. Without timely treatment, CAAs, and Potentially fatal in individual cases in particular aneurysms, can occur in up to 25% of children
Management National guidelines and guidance documents have been published from different medical societies in China, North America, Italy, UK and Germany (https://rcpch.ac.uk; Venturini 2020, Chiotos 2020, Liu 2020; https://www.rcpch.ac.uk/key-topics/covid-19; https://dgpi.de/stellungnahme-medikamentoese-behandlung-von-kindernmit-covid-19/)
Infection control in the medical setting Early identification of COVID-19 and quarantine of contacts is imperative. In the in- and out-patient setting it is advised to separate children who have infectious diseases from healthy non-infectious children. Nosocomial outbreaks have played a role in the clustering of COVID-19. It is advised to admit children with COVID-19 to the hospital only if an experienced pediatrician feels it is medically necessary (e.g. tachypnea, dyspnea, oxygen levels below 92%). In the hospital the child with COVID-19 or suspicion of COVID-19 needs to be isolated in a single room or admitted to a COVID-19-only ward in which COVID-19-exposed medical personnel is protected by non-pharmacological interventions (wearing FFP-2 masks, gowns, etc.) and maintains distance and is cohorted themselves (e.g. no shifts on other wards). The presence of one parent is not negotiable in the care of the sick child both for emotional reasons as well as for help in the nursing of the child. At present it is not recommended to separate healthy newborns from mothers with suspicion of COVID-19 (CDC-2 2020). Clearly, a preterm or newborn COVID Reference ENG 006.9
