Ispitivanje specifičnosti kovid-19 infekcije kod dece i uticaja bolesti na kvalitet života
Examining the properties of COVID-19 in children and impact of the disease on the quality of life
Докторанд
Prijić, AndrejaМентор
Maksimović, NatašaЧланови комисије
Vujić, DraganaGazibara, Tatjana
Rančić, Nataša
Метаподаци
Приказ свих података о дисертацијиСажетак
UVOD: Kovid-19 je bolest uzrokovana SARS-CoV-2, a koja je prvi put registrovana decembra
2019. godine u Kini. Svetska zdravstvena organizacija je februara 2020. godine proglasila
pandemiju kovid-19. Deca ređe obolevaju od kovid-19 u odnosu na odrasle, uglavnom se
inficiraju kapljičnim putem u domaćinstvu od članova porodice, imaju blažu kliničku sliku i
bolju prognozu bolesti. Neselektivna upotreba antimikrobnih lekova u lečenju obolele dece
predstavljala je jedan od glavnih problema tokom pandemije. S obzirom na to da je kovid-19
infekcija pretnja svetskih razmera, pored uticaja na zdravstveno stanje, uočen je i uticaj na
kvalitet života obolele dece.
CILJ: Ciljevi istraživanja bili su: ispitati demografske karakteristike dece obolele od kovida-19,
kao i prisustvo prethodnih hroničnih oboljenja; proceniti karakter i stepen težine kliničkih
simptoma i znakova kovida-19 kod dece u različitim uzrasnim grupama; ispitati stepen
zasićenosti hemoglobina kiseonikom, laboratorijske karakterist...ike, radiografski nalaz i
kompjuterizovanu tomografiju grudnog koša kod dece sa infekcijom SARS-CoV-2; proceniti
terapijske protokole i prediktore za primenu i dužinu trajanja antimikrobne terapije;
proceniti kvalitet života dece dve godine nakon preležane infekcije SARS-CoV-2.
METOD: Prospektivna kohortna studija je sprovedena u Kliničko-bolničkom centru „Dr D.
Mišović – Dedinje“, nacionalnom centru za lečenje dece obolole od kovida-19. Prvo je
sprovedena studija preseka, u okviru koje su regrutovani ispitanici za longitudinalno praćenje.
Istraživanje je uključilo svu decu sa dokazanom infekcijom SARS-CoV-2 (N = 127), koja su
hospitalizovana u periodu od 6. marta do 31. maja 2020. godine (prvi talas pandemije u
Srbiji). Demografski, klinički i laboratorijski podaci su prikupljani iz medicinske
dokumentacije. Dve godine nakon preležane infekcije, procenjivan je kvalitet života kod 81
deteta pomoću KINDL upitnika.
REZULTATI: Prosečan uzrast ispitanika je bio 7,9 ± 5,5 godina. Većina (95%) dece je imala
kontakt sa kovid-19 pozitivnim ukućanima. Najčešći simptomi i znaci kod dece obolele od
kovida-19 bili su: povišena telesna temperatura (45,7%), tahikardija (29,1%) i kašalj (26,8%).
Zapaljenje pluća je registrovano kod 1/4 ispitanika, neutropenija i limfocitoza kod više od
polovine ispitanika, povišene koncentracije C-reaktivnog proteina (CRP) (> 10 mg/L) kod 4%,
a parametri oštećenja jetre kod 20% obolelih. Antimikrobna terapija je primenjivana kod
47,2% ispitanika, a najveći broj dece je primao azitromicin (37,8%) i ceftriakson (22,8%).
Najvažniji prediktori upotrebe antimikrobnih lekova bili su povišena telesna temperatura (UO
4,32; 95% CI: 1,77, 10,56; p = 0,001) i radiografski nalaz zapaljenja pluća (UO 7,42; 95% CI:
2,52, 21,83; p = 0,001). Sva deca sa aktivnom hroničnom bolešću (N = 4) su imala pneumoniju
sa potrebom za antimikrobnim lekovima, od čega je dvoje dece je bilo na terapiji dodatnim
kiseonikom, a kod jednog ispitanika sa varijantom Guillan-Barré sindroma bila je potrebna
primena mehaničke ventilacije. Prediktori upotrebe većeg broja antimikrobnih lekova kod
dece uzrasta 1–5 godina bili su muški pol (B = -0,65; 95% CI: -1,17, -0,13; p = 0,018), odsustvo
kovida-19 u porodici (B = -1,38, 95% CI: -2,43, -0,34; p = 0,011), povišena koncentracija CRP-a
(B = 0,12; 95% CI: 0,07, 0,17; p = 0,001) i radiografski verifikovana pneumonija (B = 0,81;
95% CI: 0,34, 1,29; p = 0,002). Navedene varijable i febrilnost na prijemu (B = 3,20; 95% CI:
1,03, 5,37; p = 0,006), bili su značajni prediktori dužeg trajanja antimikrobnog lečenja...
BACKGROUND: COVID-19 is an infectious disease caused by the SARS-CoV-2, registered in
December 2019 in China for the first time. In February 2020, the World Health Organization
declared the COVID-19 pandemic. Compared to adults, children get affected less often, they
are mostly infected from family members, have milder clinical manifestations and better
prognosis. Misuse of antibiotics to treat children with COVID-19 is one of the major issues
during the pandemic. Because COVID-19 poses a global threat to health of children, their
quality of life may be affected as well.
OBJECTIVES: The objectives of the research were: to examine the demographic
characteristics of children with COVID-19, as well as the presence of previous chronic
diseases; to evaluate clinical manifestations of COVID-19 in children in different age groups;
to examine oxygen saturation level, laboratory characteristics, radiographic and computed
tomography findings in children with SARS-CoV-2 infection; to investigate ...therapeutic
protocols and predictors for the antibiotic treatment; to evaluate the quality of life in children
two years after the recovery from SARS-CoV-2 infection.
METHODS: A prospective cohort study was conducted at the Clinical Centre "Dr. D. Mišović –
Dedinje", a national centre for COVID-19 treatment in children. First, a cross-sectional study
was conducted when participants were recruited for the longitudinal follow-up. The research
included all children with proven SARS-CoV-2 infection (N = 127), who were hospitalized in
the period from March 6 to May 31, 2020 (the first wave of the pandemic in Serbia).
Demographic, clinical and laboratory data were collected from medical records. The quality of
life of 81 children was assessed, using the KINDL questionnaire, two years after the recovery
from the infection.
RESULTS: The average age of the patients was 7.9 ± 5.5 years. Most children (95%) had
contact with COVID-19 positive family members. The most common manifestations in
paediatric patients with COVID-19 were fever (45.7%), tachycardia (29.1%) and cough
(26.8%). Pneumonia was registered in 1/4 of the subjects, neutropenia and lymphocytosis in
more than one-half, elevated C-reactive protein (CRP) concentration (> 10 mg/L) in 4%, and
liver injury parameters in 20% of patients. Antibiotics were used in 47.2% of participants,
mostly azithromycin (37.8%) and ceftriaxone (22.8%). The most important predictors of the
antibiotic administration were fever (OR 4.32; 95% CI: 1.77, 10.56; p = 0.001) and
radiographic findings of pneumonia (OR 7.42; 95% CI: 2.52, 21.83; p = 0.001). All patients
with active chronic disease (N = 4) had pneumonia treated with antibiotics, two children were
on supplemental oxygen therapy, and one with a variant Guillain-Barré syndrome required
mechanical ventilation. Predictors of the administration of a higher number of antibiotics in
children aged 1–5 years were: being a boy (B = -0.65; 95% CI: -1.17, -0.13; p = 0.018), absence
of COVID-19 in the family (B = -1.38, 95% CI: -2.43, -0.34; p = 0.011), higher CRP
concentration (B = 0.12; 95% CI: 0.07, 0.17; p = 0.001) and radiographically verified
pneumonia (B = 0.81; 95% CI: 0.34, 1.29; p = 0.002). These parameters, along with fever (B =
3.20; 95% CI: 1.03, 5.37; p = 0.006), were associated with a longer duration of the antibiotic
treatment...