PEDIATRIC CRITICAL CARE

IN COVID-19 AND MIS-C

Tiona Romauli
TOPIK BAHASAN…
qPediatric Covid-19 (Severe and Critical)
qMultisystem inflammatory syndrome in children (MIS-C)
qPediatric Assessment Triangle (Segitiga Asesment Gawat Anak)
qPediatric early warning score (PEWS) / Skor Deteksi Awal Gawat
Anak (SADEWA)
PEDIATRIC VS ADULT COVID 19

•Children have significantly lower

angiotensin-converting enzyme 2
(ACE2) and transmembrane protease
serine 2 (TMPRSS2) expression within
epithelial lung cells.
•Adults naturally produce higher levels
of inflammatory cytokines, such as
interleukin-6 (IL-6), tumor necrosis
factor alpha (TNF-α), and IL-1β, and
may therefore be more vulnerable to
this COVID-19 hyperinflammatory
state.
J Pediatr Pharmacol Ther. 2021; 26(4): 318–338.

J Pediatr Pharmacol Ther. 2021; 26(3): 220–239.

Irfan O, Muttalib F, Tang K, et al. Arch Dis Child 2021;106:440–448.
 COMORBIDITY CHARACTERISTICS OF 9,353 PEDIATRIC
PATIENTS WITH COMORBIDITIES AND COVID-19 INFECTION
FOR WHOM DATA IS AVAILABLE ACROSS THE 42 STUDIES.
COMORBIDITY TOTAL (%)A COMORBIDITY TOTAL (%)A
Chronic respiratory disease 4,580 (49.0) Obesity 507 (5.4)
Asthma 209 Neurologic disorders 218 (2.3)
Other conditions 1,628 (17.4) Epilepsy 12
Prematurity 70
Seizure disorder 7
Malnutrition 2
Immune disorders 754 (8.1) Autism 3
Immunosuppression 599 Cerebral palsy 3
Renal disorders 140 (1.5)
Autoimmune 87
Hematologic disorders 89 (1.0)
Cardiovascular disease 621 (6.6)
Cancer 83 (0.9)
Hypertension 100
Leukemia 8
Congenital heart disease 41 Hepatobiliary disease 71 (0.8)
Metabolic disorders 556 (5.9) Allergy 46 (0.5)
Diabetes 520 Gastrointestinal disorders 27 (0.3)
https://doi.org/10.1016/j.prrv.2020.08.001
 PEDIATRIC ASSESSMENT TRIANGLE
(SEGITIGA ASESMENT GAWAT ANAK)
 First Impression à Pediatric Assessment Triangle (PAT)

RAPID evaluation tool à FIRST LOOK

Using only VISUAL and AUDITORY clues
Identify :
­Sick or not sick
­Stable vs unstable
­Help identify underlying physiological abnormality
­Early intervention
PATIENT ASSESSMENT
First Impression à Pediatric
Assessment Triangle (PAT)

Primary Survey (ABCDE)

Pemeriksaan lanjutan (sekunder)

Mnemonic : TICLS
Relationship of the PAT Components to Physiological Categories

Shock
Stabil
terkompensasi

Distres Shock Gagal Jantung

Pernapasan Dekompensasi Paru

Gagal Napas Gangguan SSP /

Metabolik
Primary Survey (ABCDE)

Quickly find and treat life-threatening conditions

Airway, Breathing, Circulation, Disability and
Exposure
Pemeriksaan lanjutan (sekunder)

•Anamnesis mendalam
•‘Head-to-toe examination’
CASE 1
APA KESAN SAUDARA?
A. Stabil
B. Distress pernapasan
C. Gagal napas
D. Gangguan SSP/ metabolik
E. Gagal jantung paru
CASE 2
APA KESAN SAUDARA?
A. Stabil
B. Distress pernapasan
C. Gagal napas
D. Gangguan SSP/ metabolik
E. Gagal jantung paru
PEDIATRIC EARLY WARNING SCORE
(PEWS)
 PAT
Primary Ass
Secondary Ass
 Usia Nadi saat Nafas saat
istirahat istirahat
(detik/meni (detik/meni
t) t)
Neonatus 0 – 1 bulan 100 – 180 40 – 60
Bayi 1 – 12 100 – 180 35 – 40
bulan
Balita 13 – 36 70 – 110 25 – 30
bulan
Pra- 4 – 6 tahun 70 – 110 21 – 23
Sekolah
Sekolah 7 – 12 70 – 110 19 – 21
tahun
Remaja 13 – 19 55 – 90 16 – 18
tahun
Skor 0-2 (Hijau)
• Pasien dalam keadaan stabil
• Lakukan evaluasi ulang setiap 4 jam

Skor 3-4 (kuning)

• Ada perubahan kondisi pada pasien
• Lakukan evaluasi ulang setiap 2 jam atau lebih cepat
• Laporkan ke penanggung jawab tim jaga

Skor >5 (merah)

• Ada perubahan signifikan pada kondisi pasien
• Lakukan evaluasi ulang setiap 1 jam
• Laporkan kondisi pada Dokter penangggung jawab
pasien
KESIMPULAN
•Covid-19 pada anak UMUMNYA memliki gejala lebih
ringan
•MIS-C dapat terjadi pada anak 2-6 minggu post infeksi
covid-19
•Saat bertemu pasien anak à PAT
•Evaluasi pasien secara berkala dengan PEWS/ SADEWA
untuk menilai perburukan
TERIMA KASIH