PDF(Pubmed)
Abstract：
Coronavirus disease 2019 (COVID-19) tends to have mild presentations in children. However, severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times, meriting further attention from clinicians. Meanwhile, the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.
A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included \"COVID-19 in children\", \"severe pediatric COVID-19\", and \"critical illness in children with COVID-19\".
Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.
Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included \"COVID-19 in children\", \"severe pediatric COVID-19\", and \"critical illness in children with COVID-19\".
Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.
Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
摘要：
背景：2019年冠状病毒病（COVID-19）在儿童中倾向于轻度表现。然而,严重和危重病例确实出现在儿科人群中，会产生使人衰弱的系统性影响，有时可能致命，值得临床医生进一步关注。同时,病原体毒力因子与宿主防御机制之间的复杂相互作用被认为在严重的COVID-19病理生理学中起着不可或缺的作用，但仍未完全了解。
方法：由审稿人独立使用PubMed对相关出版物进行了全面的文献综述，Embase,和万方数据库。搜索关键词包括“儿童中的COVID-19”，“重症儿科COVID-19”，和“COVID-19儿童的危重病”。
结果：儿童患严重COVID-19的风险随着合并症数量的增加和未接种疫苗的状态而升级。急性呼吸窘迫应激和坏死性肺炎是突出的肺部表现,同时也可以看到各种形式的心血管和神经系统受累。宿主对COVID-19的反应涉及多种免疫过程，包括I型干扰素和炎性体途径，其在严重和危重疾病中的失调转化为不良的临床表现。儿童多系统炎症综合征（MIS-C），与COVID-19暴露按时间顺序相关的潜在危及生命的免疫介导疾病，表示另一个科学和临床难题，举例说明了儿科免疫的复杂性。尽管儿童免疫系统和成人免疫系统之间存在相当大的差异，缺乏专门针对儿童的临床试验,目前的管理建议在很大程度上是根据成人指南改编的.
结论：重症小儿COVID-19可影响多器官系统。严重COVID-19的免疫通路失调塑造了病程，体现了儿科免疫系统的巨大功能多样性，并强调了儿童和成人之间的免疫表型差异。因此,可能需要进一步的研究,以便在儿科特定临床实践指南中充分解决这些问题.
方法：由审稿人独立使用PubMed对相关出版物进行了全面的文献综述，Embase,和万方数据库。搜索关键词包括“儿童中的COVID-19”，“重症儿科COVID-19”，和“COVID-19儿童的危重病”。
结果：儿童患严重COVID-19的风险随着合并症数量的增加和未接种疫苗的状态而升级。急性呼吸窘迫应激和坏死性肺炎是突出的肺部表现,同时也可以看到各种形式的心血管和神经系统受累。宿主对COVID-19的反应涉及多种免疫过程，包括I型干扰素和炎性体途径，其在严重和危重疾病中的失调转化为不良的临床表现。儿童多系统炎症综合征（MIS-C），与COVID-19暴露按时间顺序相关的潜在危及生命的免疫介导疾病，表示另一个科学和临床难题，举例说明了儿科免疫的复杂性。尽管儿童免疫系统和成人免疫系统之间存在相当大的差异，缺乏专门针对儿童的临床试验,目前的管理建议在很大程度上是根据成人指南改编的.
结论：重症小儿COVID-19可影响多器官系统。严重COVID-19的免疫通路失调塑造了病程，体现了儿科免疫系统的巨大功能多样性，并强调了儿童和成人之间的免疫表型差异。因此,可能需要进一步的研究,以便在儿科特定临床实践指南中充分解决这些问题.
