| Sažetak | Uvod: COVID-19 u djece uzrokuje blagu bolest koja kliničkim tijekom nalikuje ostalim
respiratornim infekcijama, no bolest može biti kritična te rezultirati, iako rijetko, smrtnim
ishodom. Nedovoljne spoznaje o patofiziologiji virusa, ulozi djece u transmisiji te manjkavi
klinički podaci o liječenju predstavljaju glavne izazove u svakodnevnom radu.
Predmet i cilj: Prikazati dobne i spolne karakteristike pacijenata oboljelih od COVID-19 te
njihovu simptomatologiju, težinu kliničke slike i modalitete liječenja. Učinjene su usporedbe
simptoma, trajanja hospitalizacije i težine bolesti s obzirom na dob, epidemijske valove,
komorbiditete i koinfekcije. -----
Metode: Retrospektivno istraživanje uključilo je 490 djece liječene u Klinici za infektivne
bolesti „Dr. Fran Mihaljević“ bilo ambulantno, u dnevnoj bolnici ili stacionarno tijekom
perioda od 01.03.2020. do 01.03.2022. Za kontinuirane varijable iskazane su deskriptvne
statističke vrijednosti, a za kategorijske varijable apsolutne i relativne frekvencije. Numeričke
varijable uspoređene su Mann Whitney U testom, odnosno Kruskal Wallisovim testom, a
kategorijske hi kvadratom, uz odgovarajuće post hoc testove za usporedbu više skupina.
Pacijenti su kategorizirani s obzirom na dob (<1, 1-4, 5-9, 10-14, 15-19 godina), s obzirom na
komorbiditete te s obzirom na prisutnost koinfekcije. -----
Rezultati: Prosječna dob ispitanika bila je 59,71 mjeseci. Muški ispitanici činili su 51,84%
oboljelih. Zabilježena su 2 smrtna ishoda (2/490; 0,41%). Između hospitaliziranih i
izvanbolnički liječenih pacijenata utvrđena je razlika u srednjoj dobi (77,1 naprema 46,12;
p<0,001). Udio bolnički liječenih razlikovao se među epidemijskim valovima (11,84% u
četvrtom, 48,00% u trećem, 53,66% u drugom te 35,30% u prvom, p<0,001). Bolovi u
abdomenu (p=0,01) i prsima (p<0,006) te glavobolja (p=0,03) bili su češći u starije djece, dok
je u mlađe djece i dojenčadi bila češća pospanost (p<0,001). Identificirano je 50 slučajeva MISC-
a, a najčešći simptomi bili su bol u abdomenu (58,00%) i osip (60,00%). U 32/50 (64,00%)
MIS-C pacijenata korišteni su kortikosteroidi, u 9/50 (18,00%) suportivna respiratorna terapija,
a u 22/50 (44,00%) vazoaktivna potpora. Među hospitaliziranima s COVID-19 28/144
(19,44%) je primilo koritkosteroide, 24/144 (16,67%) remdesivir, kisik 40/144 (27,78%), a
vazoaktivnu potporu samo 2/144 (1,39%). -----
Zaključak: COVID-19 je u djece uglavnom blaga bolesti, koja ponekad može imati teški
klinički tijek. Studija je dokazala značajno veći udio teško bolesnih među djecom s
neneurološkim (p=0,01) i kombiniranim komorbiditetom (p<0,001) u usporedbi sa zdravom
djecom, uz izostanak istih razlika među djecom koja imaju isključivo COVID-19. Pacijenti s
koinfekcijom imali su dulje trajanje hospitalizacije (8,86 dana spram 4,98 dana, p<0,001).
Također, studija je pokazala značajne promjene dobne distribucije kroz pandemijsko razdoblje
s porastom udjela oboljele dojenčadi od prvog (32,25%) do četvrtog vala (72,37%). |
| Sažetak (engleski) | Introduction: COVID-19 in children causes a mild disease that resembles other respiratory
infections in its clinical course, but the disease can be critical and result, albeit rarely, in death.
Insufficient knowledge about the pathophysiology of the virus, the role of children in
transmission, and insufficient clinical data on treatment represent the main challenges in
everyday work. -----
Aim: To present the age and gender characteristics of patients infected with COVID-19, as
well as their symptomatology, the severity of the clinical picture and treatment modalities. In
addition, comparisons were made between symptoms, duration of hospitalization and disease
severity in respect of age, epidemic waves, comorbidities and co-infections. ------
Methods: A retrospective study included 490 children admitted at the emergency clinic, day
hospital or in-stay treatment during the period from 1.03.2020. until 1.03.2022. Descriptive
values were calculated for continuous variables, and frequencies for categorical variables for
comparison of which Mann Whitney, Kruskal Wallis and chi square with corresponding post
hoc test were used, respectively. Patients were categorized according to age (<1, 1-4,5-9, 10-
14, 15-19 years), comorbidities and presence of coinfection. ------
Results: The average age of the subjects was 59,71 months. Male subjects accounted for
51,84% of patients. 2 deaths were recorded (2/490; 0,41%). Between hospitalized and
outpatient treated patients, a difference was found in the mean age (77,1 vs. 46,12; p<0.001)
during and rate of hospitalisation was different between epidemic waves (11,84% in the fourth,
48.00% in the third, 53.66% in the second and 35,30% in the first, p<0,001). Pain in the
abdomen (p=0,01) and chest (p<0,006) and headache (p=0.03) were more common in older
children, while drowsiness was more common in younger children and infants (p<0,001). 50
cases of MIS-C were identified, and the most common symptoms were abdominal pain
(58,00%) and rash (60,00%). Among MIS-C patients, corticosteroids were used in 32/50
(64,00%), supportive respiratory therapy in 9/50 (18,00%), and vasoactive support in 22/50
(44,00%). Among those with COVID-19, 28/144 (19,44%) received corticosteroids, 24/144
(16,67%) remdesivir, oxygen 40/144 (27,78%), and vasoactive support only 2/144 (1,39%). -----
Conclusion: In children, COVID-19 is mostly a mild disease, which can sometimes have a
severe clinical course. Among all hospitalised patients, this study showed a higher proportion
of seriously ill among children with non-neurological (p=0.01) and combined comorbidities
(p<0.001) compared to healthy children, with the absence of these differences among children
who only have COVID-19. Patients with co-infection had a longer duration of hospitalization
(8.86 days vs. 4.98 days, p<0.001). Significant change in the age distribution throughout the
pandemic period with an increase in the proportion of sick infants from the first (32.25%) to
the fourth wave (72.37%) was noticed. |
