RESUMO
The pediatric population accounts for a small portion of those with severe disease related to COVID-19. There are few published reports of hypercoagulable states in children with COVID-19. We describe an 11-year-old male with nephrotic syndrome who required inpatient treatment for COVID-19 pneumonia eight weeks prior. He returned to the emergency department with vomiting, tachypnea and was found to have a pulmonary embolism. In this case report, we discuss the risk factors for, presentation and evaluation of hypercoagulable state and its relation to COVID-19 in a pediatric patient.
Assuntos
COVID-19/sangue , Síndrome Nefrótica/complicações , Embolia Pulmonar/diagnóstico , Doença Cardiopulmonar/diagnóstico , Trombofilia/sangue , COVID-19/complicações , Criança , Angiografia por Tomografia Computadorizada , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Hospitalização , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Readmissão do Paciente , Obesidade Infantil/complicações , Embolia Pulmonar/sangue , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Doença Cardiopulmonar/tratamento farmacológico , Doença Cardiopulmonar/etiologia , SARS-CoV-2 , Taquipneia , Trombofilia/complicações , Trombofilia/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , VômitoRESUMO
OBJECTIVE: To demonstrate the association between the duration of significant patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD) in extremely preterm infants. METHODS: All extremely preterm infants (<29 weeks) treated in our Neonatal Intensive Care Unit from January 2013 to March 2016 were included if their PDA status was confirmed at <7 days of life. Infants with genetic syndromes, complex congenital anomalies and insignificant PDAs were excluded. Total duration of significant PDA was estimated by reviewing serial echocardiograms. Significant PDA was diagnosed using our scoring system that was based upon echocardiographic parameters and clinical status of the infants. Study cohort was divided into four groups based on the duration of significant PDA. Group A-No PDA, Group B-PDA <1-week, Group C- PDA 1-2 weeks, and Group D-PDA >2 weeks. ANOVA and multivariate analysis were performed to compare the groups. RESULTS: There were 147 infants with no PDA (Group A), 50, 35, and 41 infants were enrolled in Groups B, C, and D, respectively. There were no differences in maternal and neonatal variables among groups except for the following: maternal smoking, chorioamnionitis, antenatal indomethacin, gestation, birth weight, mode of delivery and incidence of death or BPD. Logistic regression analysis showed that longer duration of significant PDA was associated with higher risk for death or BPD (adjusted OR 1.37, 95% CI 1.03-1.82). CONCLUSION: Longer duration of significant PDA is associated with the higher risk for BPD/death in extremely preterm infants.