Abstract：
Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn\'s and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison.
We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results were discussed at a moderated meeting prior to a second survey.
Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19.
Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.
We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results were discussed at a moderated meeting prior to a second survey.
Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19.
Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.
摘要：
由于对免疫抑制的依赖和手术的潜力，新型SARS-CoV-2/COVID-19大流行期间的儿科急性严重结肠炎（ASC）管理具有挑战性。我们旨在通过欧洲克罗恩病和结肠炎组织/欧洲儿科胃肠病学会提供COVID-19的特定指导，肝病学和营养指南的比较。
我们召集了一个由14名儿科胃肠病学家和儿科外科专家组成的RAND适当性小组，风湿病,呼吸道和传染病。小组成员评估了在COVID-19大流行背景下对ASC进行干预的适当性。在第二次调查之前，在主持会议上讨论了结果。
小组成员建议ASC患者在入院时进行SARS-CoV-2拭子和快速生物筛查，应进行隔离。阳性拭子应引发与COVID-19专家的讨论。建议在升级到二线治疗或结肠切除术之前进行乙状结肠镜检查。甲基强的松龙被认为是适当的一线管理，包括有症状的COVID-19。所有患者也建议预防血栓。在需要二线治疗的患者中，无论SARS-CoV-2状态如何,英夫利昔单抗均被认为是合适的.由于SARS-CoV-2感染而延迟结肠切除术被认为是不合适的。皮质类固醇在8-10周内逐渐减少被认为对所有人都是合适的。皮质类固醇抢救成功后，在SARS-CoV-2拭子阴性的患者和拭子阳性的无症状患者中，硫嘌呤维持治疗被认为是合适的，但在有症状的COVID-19中不确定。
我们使用RAND小组对儿科ASC指南的COVID-19特异性适应通常支持现有建议，特别是使用皮质类固醇和升级为英夫利昔单抗，无论SARS-CoV-2状态如何。建议考虑常规预防性抗凝治疗。
我们召集了一个由14名儿科胃肠病学家和儿科外科专家组成的RAND适当性小组，风湿病,呼吸道和传染病。小组成员评估了在COVID-19大流行背景下对ASC进行干预的适当性。在第二次调查之前，在主持会议上讨论了结果。
小组成员建议ASC患者在入院时进行SARS-CoV-2拭子和快速生物筛查，应进行隔离。阳性拭子应引发与COVID-19专家的讨论。建议在升级到二线治疗或结肠切除术之前进行乙状结肠镜检查。甲基强的松龙被认为是适当的一线管理，包括有症状的COVID-19。所有患者也建议预防血栓。在需要二线治疗的患者中，无论SARS-CoV-2状态如何,英夫利昔单抗均被认为是合适的.由于SARS-CoV-2感染而延迟结肠切除术被认为是不合适的。皮质类固醇在8-10周内逐渐减少被认为对所有人都是合适的。皮质类固醇抢救成功后，在SARS-CoV-2拭子阴性的患者和拭子阳性的无症状患者中，硫嘌呤维持治疗被认为是合适的，但在有症状的COVID-19中不确定。
我们使用RAND小组对儿科ASC指南的COVID-19特异性适应通常支持现有建议，特别是使用皮质类固醇和升级为英夫利昔单抗，无论SARS-CoV-2状态如何。建议考虑常规预防性抗凝治疗。
