{"id":7012,"date":"2020-08-27T03:36:46","date_gmt":"2020-08-26T20:36:46","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khac\/2020\/08\/27\/nhi-khoa-va-covid\/"},"modified":"2024-03-17T05:59:41","modified_gmt":"2024-03-16T22:59:41","slug":"nhi-khoa-va-covid","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/du-an-khac\/nhi-khoa-va-covid\/","title":{"rendered":"Nhi Khoa v\u00e0 COVID"},"content":{"rendered":"

L\u1eddi c\u1ea3m \u01a1n: Quy\u1ec3n s\u00e1ch n\u00e0y s\u1ebd kh\u00f4ng th\u1ec3 ho\u00e0n th\u00e0nh n\u1ebfu kh\u00f4ng c\u00f3 s\u1ef1 gi\u00fap \u0111\u1ee1 t\u1eadn t\u00ecnh c\u1ee7a Andrea Groth (Helios Klinikum Krefeld). Ch\u00fang t\u00f4i xin ch\u00e2n th\u00e0nh c\u1ea3m \u01a1n BS. Lars Dinkelbach<\/strong> (Heinrich Heine Universit\u00e4t D\u00fcsseldorf) \u0111\u00e3 hi\u1ec7u \u0111\u00ednh.<\/em><\/p>\n

Nhi\u1ec5m SARS-CoV-2 \u1edf tr\u1ebb em<\/h2>\n

C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 nguy c\u01a1 m\u1eafc ph\u1ea3i SARS-CoV-2 \u1edf tr\u1ebb em so v\u1edbi ng\u01b0\u1eddi l\u1edbn \u0111\u00e3 cho th\u1ea5y c\u00e1c k\u1ebft qu\u1ea3 tr\u00e1i ng\u01b0\u1ee3c nhau (Mehta 2020<\/a>, Gudbjartsson 2020<\/a>, Bi 2020<\/a>). Vai tr\u00f2 x\u00e1c \u0111\u1ecbnh tr\u1ebb em trong qu\u00e1 tr\u00ecnh l\u00e2y nhi\u1ec5m SARS-CoV-2 ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u \u0111\u1ea7y \u0111\u1ee7. C\u00e1c nghi\u00ean c\u1ee9u d\u1ef1a tr\u00ean qu\u1ea7n th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n cho \u0111\u1ebfn nay, cho th\u1ea5y tr\u1ebb em c\u00f3 th\u1ec3 kh\u00f4ng ph\u1ea3i l\u00e0 y\u1ebfu t\u1ed1 ch\u00ednh trong vi\u1ec7c lan truy\u1ec1n b\u1ec7nh COVID-19 (Gudbjartsson 2020<\/a>). V\u1eabn \u0111ang thi\u1ebfu c\u00e1c b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 huy\u1ebft thanh h\u1ecdc.<\/p>\n

Di\u1ec5n ti\u1ebfn COVID-19 \u1edf tr\u1ebb em th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c \u00edt nghi\u00eam tr\u1ecdng h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn (Zimmermann 2020<\/a>, Parri 2020<\/a>, Ludvigsson 2020<\/a>). V\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y, COVID kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c b\u1ec7nh h\u00f4 h\u1ea5p do virus kh\u00e1c m\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong (v\u00ed d\u1ee5 RVS \u1edf tr\u1ebb s\u01a1 sinh). \u0110\u1ea1i d\u1ecbch SARS-CoV-2 g\u00e2y ra m\u1ed9t t\u1ed5n h\u1ea1i l\u1edbn ngo\u00e0i \u00fd mu\u1ed1n v\u1edbi tr\u1ebb em khi ph\u1ea3i xa m\u00f4i tr\u01b0\u1eddng gi\u00e1o d\u1ee5c (nh\u00e0 gi\u1eef tr\u1ebb, tr\u01b0\u1eddng h\u1ecdc,…) v\u00e0 v\u00ec cha m\u1eb9 lo l\u1eafng v\u1ec1 Covid 19 t\u00ecm ki\u1ebfm ph\u01b0\u01a1ng th\u1ee9c d\u1ef1 ph\u00f2ng m\u00e0 qu\u00ean c\u00e1c nhu c\u1ea7u y t\u1ebf kh\u00e1c nh\u01b0\u00a0 ti\u00eam ph\u00f2ng (Bramer 2020<\/a>) ho\u1eb7c ngay c\u1ea3 khi con c\u00e1i c\u1ee7a h\u1ecd c\u1ea7n \u0111\u01b0\u1ee3c c\u1ea5p c\u1ee9u (Lazzerini 2020<\/a>).<\/p>\n

C\u00e1c ch\u1ee7ng virus corona l\u01b0u h\u00e0nh ph\u1ed5 bi\u1ebfn \u1edf tr\u1ebb em: \u00e1i t\u00ednh, th\u1eddi gian \u1ee7 b\u1ec7nh v\u00e0 l\u00e2y lan<\/strong><\/h3>\n

H\u1ed9i th\u1ea3o v\u1ec1 Virus Corona Qu\u1ed1c T\u1ebf \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c t\u1ed5 ch\u1ee9c b\u1edfi Volker Termeulen t\u1ea1i W\u00fcrzburg \/ \u0110\u1ee9c v\u00e0o n\u0103m 1980. V\u00e0o th\u1eddi \u0111i\u1ec3m \u0111\u00f3, ch\u1ec9 c\u00f3 m\u1ed9t lo\u00e0i virus corona \u1edf ng\u01b0\u1eddi l\u00e0 HcoV2229E, \u0111\u01b0\u1ee3c bi\u1ebft c\u00f3 li\u00ean quan \u0111\u1ebfn c\u1ea3m l\u1ea1nh th\u00f4ng th\u01b0\u1eddng (Weiss 2020<\/a>). C\u00e1c virus corona \u1edf ng\u01b0\u1eddi l\u01b0u h\u00e0nh ph\u1ed5 bi\u1ebfn c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp t\u1eeb 4-8% trong t\u1ed5ng s\u1ed1 tr\u1ebb b\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh, th\u01b0\u1eddng l\u00e0 b\u1ec7nh nh\u1eb9, tr\u1eeb khi tr\u1ebb b\u1ecb suy gi\u1ea3m mi\u1ec5n d\u1ecbch (Ogimi 2019<\/a>). B\u1ea3y ch\u1ee7ng virus corona l\u01b0u h\u00e0nh \u1edf ng\u01b0\u1eddi l\u00e0: \u03b1-Coronaviruses HCoV2-229e, -HKU1; \u03b2-Coronaviruses HCoV2-NL63, -OC43; MERS-CoV, SARS-CoV and SARS-CoV-2, trong \u0111\u00f3 ch\u00fang b\u1eaft ngu\u1ed3n t\u1eeb lo\u00e0i d\u01a1i (NL63, 229e, SARS-CoV), l\u1ea1c \u0111\u00e0 m\u1ed9t b\u01b0\u1edbu (229e, MERS-CoV), gia s\u00fac (OC43), t\u00ea t\u00ea (SARS-CoV-2) (Zimmermann 2020<\/a>). D\u01b0\u1eddng nh\u01b0 c\u00f3 s\u1ef1 t\u00e1i nhi\u1ec5m v\u1edbi c\u00e1c virus corona ph\u1ed5 bi\u1ebfn \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 tr\u01b0\u1edbc \u0111\u00f3 m\u1eb7c d\u00f9 th\u1ef1c t\u1ebf h\u1ea7u h\u1ebft c\u00e1c c\u00e1 th\u1ec3 c\u00f3 s\u1ef1 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh \u0111\u1ed1i v\u1edbi virus corona \u1edf ng\u01b0\u1eddi. \u1ede nhi\u1ec1u tr\u1ebb em c\u00f3 s\u1ef1 \u0111\u1ed3ng nhi\u1ec5m v\u1edbi c\u00e1c lo\u1ea1i virus kh\u00e1c nh\u01b0 virus Adeno-, Boca-, Rhino-, RSV-, Influenza- ho\u1eb7c Parainfluenza. C\u00f3 v\u1ebb t\u1ed3n t\u1ea1i m\u1ed9t m\u00f4 h\u00ecnh tu\u1ea7n ho\u00e0n v\u1edbi c\u00e1c \u0111\u1ee3t d\u1ecbch theo m\u00f9a, t\u1eeb th\u00e1ng M\u01b0\u1eddi hai \u0111\u1ebfn th\u00e1ng N\u0103m ho\u1eb7c t\u1eeb th\u00e1ng Ba \u0111\u1ebfn th\u00e1ng M\u01b0\u1eddi m\u1ed9t \u1edf nam b\u00e1n c\u1ea7u.<\/p>\n

M\u1ed9t \u0111\u1eb7c \u0111i\u1ec3m chu\u1ed7i \u0111\u01a1n RNA c\u1ee7a virus corona l\u00e0 kh\u1ea3 n\u0103ng \u0111\u1ed9t bi\u1ebfn v\u00e0 t\u00e1i t\u1ed5 h\u1ee3p nhanh ch\u00f3ng t\u1ea1o ra c\u00e1c ch\u1ee7ng virus corona m\u1edbi c\u00f3 th\u1ec3 l\u00e2y lan t\u1eeb \u0111\u1ed9ng v\u1eadt sang ng\u01b0\u1eddi.\u00a0 Ch\u00fang \u0111\u00e3 g\u00e2y ra c\u00e1c v\u1ee5 d\u1ecbch c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u00e1ng k\u1ec3 (10% \u1edf b\u1ec7nh SARS-CoV t\u1ea1i H\u1ed3ng K\u00f4ng v\u00e0o n\u0103m 2002; h\u01a1n 30% \u1edf b\u1ec7nh MERS-CoV t\u1ea1i \u1ea2 R\u1eadp Saudi v\u00e0o n\u0103m 2012). V\u00ec t\u1ef7 l\u1ec7 t\u1eed vong \u1edf c\u1ea3 hai \u0111\u1ec1u cao n\u00ean c\u1ea3 SARS-CoV v\u00e0 MERS-CoV \u0111\u1ec1u \u00edt c\u00f3 kh\u1ea3 n\u0103ng l\u00e2y truy\u1ec1n c\u1ed9ng \u0111\u1ed3ng l\u00e2u d\u00e0i. Theo \u0111\u00f3, kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m SARS-CoV n\u00e0o \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o k\u1ec3 t\u1eeb th\u00e1ng 7 n\u0103m 2003.<\/p>\n

Ng\u01b0\u1eddi ta \u01b0\u1edbc t\u00ednh r\u1eb1ng, \u0111\u1ed1i v\u1edbi SARS-CoV-2, m\u1ed9t ng\u01b0\u1eddi c\u00f3 th\u1ec3 l\u00e2y nhi\u1ec5m cho 2-3 ng\u01b0\u1eddi kh\u00e1c. Trong c\u00e1c \u1ed5 d\u1ecbch (v\u00ed d\u1ee5: \u1ed5 d\u1ecbch t\u1ea1i b\u1ec7nh vi\u1ec7n), con s\u1ed1 n\u00e0y c\u00f3 th\u1ec3 cao h\u01a1n nhi\u1ec1u. Trong c\u1ea3 SARS- CoV v\u00e0 MERS-CoV, c\u00e1c tr\u01b0\u1eddng h\u1ee3p si\u00eau l\u00e2y nhi\u1ec5m \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o khi m\u1ed9t ca b\u1ec7nh l\u00e2y cho 22 (SARS) ho\u1eb7c th\u1eadm ch\u00ed 30 ng\u01b0\u1eddi kh\u00e1c (MERS), \u0111\u1eb7c bi\u1ec7t l\u00e0 trong c\u00e1c \u1ed5 d\u1ecbch t\u1ea1i b\u1ec7nh vi\u1ec7n. V\u1edbi SARS-CoV, t\u1ed5ng c\u1ed9ng c\u00f3 41 tr\u1ebb em \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nhi\u1ec5m b\u1ec7nh v\u00e0 kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong. T\u01b0\u01a1ng t\u1ef1, \u1edf MERS-CoV, ch\u1ec9 c\u00f3 38 tr\u1ebb em \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o b\u1ecb nhi\u1ec5m b\u1ec7nh trong hai nghi\u00ean c\u1ee9u, v\u1edbi ch\u1ec9 2 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong (Zimmermann 2020<\/a>).<\/p>\n

D\u1ecbch t\u1ec5 h\u1ecdc COVID-19 \u1edf tr\u1ebb em<\/h2>\n

\"NhiV\u00e0o ng\u00e0y 6 th\u00e1ng 4, CDC M\u1ef9 \u0111\u00e3 b\u00e1o c\u00e1o c\u00f3 2.572 (1,7%) tr\u1ebb em d\u01b0\u1edbi 18 tu\u1ed5i m\u1eafc COVID-19 trong s\u1ed1 149.082 ca nhi\u1ec5m t\u1eeb ng\u00e0y 12 th\u00e1ng 2 \u0111\u1ebfn ng\u00e0y 2 th\u00e1ng 4 n\u0103m 2020. D\u1eef li\u1ec7u c\u00f3 s\u1eb5n h\u1ebft s\u1ee9c h\u1ea1n ch\u1ebf (d\u01b0\u1edbi 10% d\u1eef li\u1ec7u c\u00f3 m\u00f4 t\u1ea3 tri\u1ec7u ch\u1ee9ng, 13% d\u1eef li\u1ec7u v\u1ec1 c\u00e1c b\u1ec7nh k\u00e8m,\u00a0 33% \u0111\u1ec1 c\u1eadp li\u1ec7u tr\u1ebb c\u00f3 ph\u1ea3i nh\u1eadp vi\u1ec7n hay kh\u00f4ng). Ba tr\u01b0\u1eddng h\u1ee3p t\u1eed vong \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o cho CDC nh\u01b0ng kh\u00f4ng bao g\u1ed3m c\u00e1c th\u00f4ng tin c\u1ee5 th\u1ec3. \u0110\u1ed9 tu\u1ed5i trung v\u1ecb l\u00e0 11 v\u00e0 57% l\u00e0 tr\u1ebb trai.\u00a0 15 tr\u1ebb em ph\u1ea3i chuy\u1ec3n v\u00e0o ICU (\u22642%). Tr\u1ebb <1 tu\u1ed5i chi\u1ebfm t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n cao nh\u1ea5t (15-62%) (CDC 2020<\/a>). B\u00e1o c\u00e1o t\u1eeb CDC Trung Qu\u1ed1c (Dong 2020<\/a>) bao g\u1ed3m 2.143 b\u1ec7nh nhi t\u1eeb ng\u00e0y 16 th\u00e1ng 1 \u0111\u1ebfn ng\u00e0y 8 th\u00e1ng 2 n\u0103m 2020. Ch\u1ec9 c\u00f3 731 tr\u1ebb em (34,1%) \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1eb1ng x\u00e9t nghi\u1ec7m. \u0110\u1ed9 tu\u1ed5i trung v\u1ecb l\u00e0 7 v\u1edbi 56,6% b\u00e9 trai, d\u01b0\u1edbi 5% \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i l\u00e0 b\u1ec7nh n\u1eb7ng v\u00e0 d\u01b0\u1edbi 1% l\u00e0 nguy k\u1ecbch. M\u1ed9t tr\u1ebb 10 th\u00e1ng tu\u1ed5i \u1edf Trung Qu\u1ed1c b\u1ecb nhi\u1ec5m SARS-CoV-2 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 \u0111\u00e3 ch\u1ebft v\u00ec l\u1ed3ng ru\u1ed9t v\u00e0 suy \u0111a t\u1ea1ng (Lu X 2020<\/a>). Trung T\u00e2m Ki\u1ec3m So\u00e1t V\u00e0 Ph\u00f2ng Ng\u1eeba B\u1ec7nh T\u1eadt H\u00e0n Qu\u1ed1c v\u00e0o ng\u00e0y 20 th\u00e1ng 3 \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng 6,3% trong t\u1ed5ng s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p m\u1eafc COVID-19 l\u00e0 tr\u1ebb em d\u01b0\u1edbi 19 tu\u1ed5i; b\u00ean c\u1ea1nh \u0111\u00f3, tr\u1ebb em \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 ch\u1ec9 m\u1eafc b\u1ec7nh nh\u1eb9 (Trung T\u00e2m Ki\u1ec3m So\u00e1t V\u00e0 Ph\u00f2ng Ng\u1eeba B\u1ec7nh T\u1eadt H\u00e0n Qu\u1ed1c. Th\u00f4ng c\u00e1o b\u00e1o ch\u00ed, https:\/\/www.cdc.go.kr<\/a>). D\u1eef li\u1ec7u c\u1ee7a \u00dd \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 v\u00e0o ng\u00e0y 18 th\u00e1ng 3 cho th\u1ea5y ch\u1ec9 c\u00f3 1,2% l\u00e0 tr\u1ebb em trong t\u1ed5ng s\u1ed1 22.512 tr\u01b0\u1eddng h\u1ee3p m\u1eafc COVID-19; kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong n\u00e0o \u0111\u01b0\u1ee3c ghi nh\u1eadn trong nghi\u00ean c\u1ee9u n\u00e0y v\u00e0 c\u1ea3 nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 \u1edf Madrid, T\u00e2y Ban Nha (ng\u00e0y 2 \u0111\u1ebfn 16 th\u00e1ng 3) (Livingstone 2020<\/a>, Tagarro 2020<\/a>).<\/p>\n

H\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t Ch\u00e2u \u00c2u (TESSy) thu th\u1eadp d\u1eef li\u1ec7u t\u1eeb c\u00e1c qu\u1ed1c gia Ch\u00e2u \u00c2u v\u00e0 V\u01b0\u01a1ng qu\u1ed1c Anh v\u1ec1 c\u00e1c ca nhi\u1ec5m COVID-19 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi ph\u00f2ng th\u00ed nghi\u1ec7m. Trong s\u1ed1 576.024 ca nhi\u1ec5m COVID-19 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1edfi ph\u00f2ng th\u00ed nghi\u1ec7m, 0.7% ca nhi\u1ec5m t\u1eeb 0-4 tu\u1ed5i, 0.6% t\u1eeb 5-9 tu\u1ed5i, 0.9% t\u1eeb 10-14 tu\u1ed5i (https:\/\/covid19-surveillance-report.ecdc.europa.eu<\/a>).<\/p>\n

Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1eabn \u0111\u1ebfn bi\u1ebfn ch\u1ee9ng b\u1ec7nh<\/h2>\n

Th\u1eddi gian \u1ee7 b\u1ec7nh \u0111\u01b0\u1ee3c cho l\u00e0 t\u1eeb 3-7 ng\u00e0y (trong kho\u1ea3ng 1-14 ng\u00e0y) (She 2020<\/a>), kh\u1edfi ph\u00e1t l\u00e2m s\u00e0ng t\u1eeb 5-8 ng\u00e0y sau khi nhi\u1ec5m virus. Tr\u1ebb em th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c b\u1ec7nh \u00edt n\u1eb7ng h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn (Zimmermann P 2020, Parri 2020<\/a>). Trong t\u1ed5ng s\u1ed1 100 tr\u1ebb nhi\u1ec5m SARS-CoV-2 \u1edf \u00dd, 21% kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, 58% b\u1ec7nh nh\u1eb9, 19% b\u1ec7nh n\u1eb7ng v\u00e0 1% \u1edf trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch (Parri 2020<\/a>).<\/p>\n

T\u1ea1i th\u1eddi \u0111i\u1ec3m 10 ng\u00e0y sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng, ph\u1ea3n \u1ee9ng vi\u00eam qu\u00e1 m\u1ee9c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n g\u00e2y b\u1ec7nh n\u1eb7ng h\u01a1n v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c nh\u00f3m nguy c\u01a1 cao. Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i trong 1-2 tu\u1ea7n, nh\u01b0ng s\u1ebd k\u00e9o d\u00e0i h\u01a1n \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ebfn ch\u1ee9ng. V\u00ec d\u1eef li\u1ec7u c\u00f2n h\u1ea1n ch\u1ebf, n\u00ean v\u1eabn ch\u01b0a r\u00f5 nh\u00f3m tr\u1ebb n\u00e0o c\u00f3 nguy c\u01a1 cao m\u1eafc bi\u1ebfn ch\u1ee9ng, v\u00ed d\u1ee5: tr\u1ebb em c\u00f3 c\u00e1c b\u1ec7nh n\u1ec1n nh\u01b0 b\u1ec7nh ph\u1ed5i ho\u1eb7c tim m\u1ea1ch, suy gi\u1ea3m th\u1ea7n kinh n\u1eb7ng, suy gi\u1ea3m mi\u1ec5n d\u1ecbch ho\u1eb7c tr\u1ebb \u0111ang trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch, v.v … T\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00fam, m\u1ed9t s\u1ed1 tr\u1ebb c\u00f3 th\u1ec3 nh\u1ea1y c\u1ea3m v\u1ec1 di truy\u1ec1n h\u01a1n (Clohisey 2019<\/a>). \u0110i\u1ec1u th\u00fa v\u1ecb l\u00e0 trong m\u1ed9t cu\u1ed9c kh\u1ea3o s\u00e1t nhanh t\u1eeb 25 qu\u1ed1c gia g\u1ed3m 10.000 tr\u1ebb em m\u1eafc ung th\u01b0 c\u00f3 nguy c\u01a1 nhi\u1ec5m COVID-19 v\u00e0 200 tr\u1ebb \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m, ch\u1ec9 c\u00f3 9 tr\u1ebb d\u01b0\u01a1ng t\u00ednh v\u1edbi SARS-CoV-2. Tr\u1ebb em th\u01b0\u1eddng m\u1eafc b\u1ec7nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng ho\u1eb7c b\u1ecb b\u1ec7nh nh\u1eb9 (Hrusak 2020<\/a>).<\/p>\n

Trong h\u1ec7 th\u1ed1ng gi\u00e1m s\u00e1t Ch\u00e2u \u00c2u (TESSy), t\u1eed vong \u1edf tr\u1ebb em d\u01b0\u1edbi 15 tu\u1ed5i l\u00e0 r\u1ea5t hi\u1ebfm, 4 trong s\u1ed1 44.695 tr\u1ebb 0.009%) \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. T\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n cao h\u01a1n \u1edf tr\u1ebb em d\u01b0\u1edbi n\u0103m tu\u1ed5i, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb s\u01a1 sinh so v\u1edbi ng\u01b0\u1eddi t\u1eeb 5-29 tu\u1ed5i. \u0110i\u1ec1u \u0111\u00f3 kh\u1eb3ng \u0111\u1ecbnh r\u1eb1ng tr\u1ebb nh\u1ecf \u00edt nh\u1eadp vi\u1ec7n h\u01a1n. \u1ede c\u00e1c tr\u1ebb nh\u1ecf h\u01a1n, b\u1ec7nh n\u1eb7ng c\u1ea7n chuy\u1ec3n v\u00e0o ICU th\u01b0\u1eddng kh\u00f4ng nhi\u1ec1u. Kh\u1ea3 n\u0103ng nh\u1eadp vi\u1ec7n cao h\u01a1n \u1edf tr\u1ebb c\u00f3 b\u1ec7nh n\u1ec1n, hi\u1ebfm g\u1eb7p di\u1ec5n ti\u1ebfn n\u1eb7ng. (https:\/\/covid19-surveillance-report.ecdc.europa.eu<\/a>).<\/p>\n

M\u1ed9t nghi\u00ean c\u1ee9u c\u1eaft ngang bao g\u1ed3m 48 tr\u1ebb m\u1eafc COVID-19 (trung b\u00ecnh 13 tu\u1ed5i, \u0111\u01b0\u1ee3c chuy\u1ec3n v\u00e0o 46 \u0110\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c Nhi \u1edf B\u1eafc M\u1ef9 t\u1eeb ng\u00e0y 14 th\u00e1ng 3 \u0111\u1ebfn 3 th\u00e1ng 4 n\u0103m 2020), 40 b\u1ec7nh nhi (83%) c\u00f3 b\u1ec7nh k\u00e8m theo \u0111\u00e1ng k\u1ec3 v\u00e0 18 b\u1ec7nh nh\u00e2n (38%) c\u1ea7n ph\u1ea3i th\u1edf m\u00e1y. C\u00e1c li\u1ec7u ph\u00e1p tr\u00fang \u0111\u00edch \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf 28 b\u1ec7nh nh\u00e2n (61%, ch\u1ee7 y\u1ebfu l\u00e0 HCQ). Hai b\u1ec7nh nh\u00e2n \u0111\u00e3 ch\u1ebft (4%) v\u00e0 15 b\u1ec7nh nh\u00e2n (31%) v\u1eabn ti\u1ebfp t\u1ee5c nh\u1eadp vi\u1ec7n, 3 b\u1ec7nh nh\u00e2n v\u1eabn c\u1ea7n h\u1ed7 tr\u1ee3 th\u1edf m\u00e1y v\u00e0 m\u1ed9t ng\u01b0\u1eddi ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ECMO (Shekerdemian 2020<\/a>).<\/p>\n

Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 h\u1ed3i c\u1ee9u quan s\u00e1t bao g\u1ed3m 177 tr\u1ebb em v\u00e0 thanh ni\u00ean c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn nhi\u1ec5m SARS-CoV-2 b\u1edfi ph\u00f2ng th\u00ed nghi\u1ec7m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trong kho\u1ea3ng th\u1eddi gian t\u1eeb ng\u00e0y 15 th\u00e1ng 3 \u0111\u1ebfn 30 th\u00e1ng 4 n\u0103m 2020 t\u1ea1i B\u1ec7nh vi\u1ec7n Nhi Qu\u1ed1c Gia \u1edf Washington, 44 tr\u1ebb ph\u1ea3i nh\u1eadp vi\u1ec7n v\u00e0 9 tr\u1ebb \u0111ang trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch. Trong \u0111\u00f3, 6\/9 l\u00e0 thanh thi\u1ebfu ni\u00ean v\u00e0 thanh ni\u00ean >15 tu\u1ed5i. M\u1eb7c d\u00f9 hen suy\u1ec5n l\u00e0 b\u1ec7nh n\u1ec1n ph\u1ed5 bi\u1ebfn nh\u1ea5t, nh\u01b0ng l\u1ea1i kh\u00f4ng nhi\u1ec1u \u1edf c\u00e1c b\u1ec7nh nh\u00e2n n\u1eb7ng (DeBiasi 2020<\/a>).<\/p>\n

T\u00ednh \u0111\u1ebfn ng\u00e0y 11 th\u00e1ng 5, 74 trung t\u00e2m \u1edf \u0110\u1ee9c \u0111\u00e3 b\u00e1o c\u00e1o 137 tr\u01b0\u1eddng h\u1ee3p nh\u1eadp vi\u1ec7n Nhi khoa, 15% ph\u1ea3i chuy\u1ec3n v\u00e0o ICU, 55.6% b\u1ec7nh nh\u00e2n \u1edf ICU c\u00f3 m\u1ed9t b\u1ec7nh n\u1ec1n, ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c b\u1ec7nh v\u1ec1 ph\u1ed5i ho\u1eb7c tim m\u1ea1ch (www.dgpi.de).<\/p>\n

Sinh l\u00fd b\u1ec7nh v\u00e0 mi\u1ec5n d\u1ecbch h\u1ecdc<\/h2>\n

Kh\u00f4ng r\u00f5 l\u00fd do t\u1ea1i sao \u1edf tr\u1ebb em, COVID-19 li\u00ean quan \u00edt h\u01a1n v\u1ec1 ti\u1ebfn tri\u1ec3n n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n

M\u00f4 h\u00ecnh bi\u1ec3u hi\u1ec7n m\u00f4 c\u1ee7a th\u1ee5 th\u1ec3 CoV-2 angiotensin chuy\u1ec3n enzyme (ACE2) v\u00e0 serine protease xuy\u00ean m\u00e0ng TMPRSS2 (c\u1ea7n thi\u1ebft cho s\u1ef1 x\u00e2m nh\u1eadp t\u1ebf b\u00e0o c\u1ee7a CoV-2) c\u0169ng nh\u01b0 t\u00ednh h\u01b0\u1edbng m\u00f4 c\u1ee7a COV-2 \u1edf tr\u1ebb em v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5. ACE2 c\u00f3 \u1edf c\u00e1c t\u1ebf b\u00e0o \u0111\u01b0\u1eddng th\u1edf, ph\u1ed5i, c\u00e1c t\u1ebf b\u00e0o ni\u00eam m\u1ea1c (mi m\u1eaft, m\u00ed m\u1eaft, khoang m\u0169i), ru\u1ed9t v\u00e0 tr\u00ean c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch (b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n, t\u1ebf b\u00e0o lympho, b\u1ea1ch c\u1ea7u trung t\u00ednh) (Molloy 2020<\/a>, b\u00e0i t\u1ed5ng quan c\u1ee7a Brodin 2020<\/a>). C\u1ea7n l\u00e0m r\u00f5 li\u1ec7u virus c\u00f3 t\u1ea5n c\u00f4ng c\u00e1c t\u1ebf b\u00e0o th\u1ea7n kinh hay kh\u00f4ng (v\u00ed d\u1ee5: \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u00e3o b\u1ed9 \u0111ang ph\u00e1t tri\u1ec3n c\u1ee7a tr\u1ebb s\u01a1 sinh).<\/p>\n

C\u01a1 quan \u0111\u00edch c\u1ee7a virus SARS-CoV-2 l\u00e0 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ef1c k\u1ef3 ph\u1ed5 bi\u1ebfn \u1edf tr\u1ebb em, ng\u01b0\u1eddi ta d\u1ef1 \u0111o\u00e1n r\u1eb1ng c\u00f3 nh\u1eefng lo\u1ea1i virus kh\u00e1c c\u00f9ng t\u1ed3n t\u1ea1i v\u1edbi virus corona trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ee7a tr\u1ebb, \u0111i\u1ec1u \u0111\u00f3 c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 t\u0103ng sinh c\u1ee7a SARS-CoV-2. C\u00e1c \u0111o l\u01b0\u1eddng t\u1ea3i l\u01b0\u1ee3ng h\u1ec7 th\u1ed1ng c\u1ee7a c\u00e1c virus kh\u00e1c nhau trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p \u1edf tr\u1ebb em \u0111ang \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh. \u0110i\u1ec3m m\u1ea5u ch\u1ed1t trong c\u00e1c giai \u0111o\u1ea1n b\u1ec7nh h\u1ecdc mi\u1ec5n d\u1ecbch mu\u1ed9n c\u1ee7a vi\u00eam ph\u1ed5i COVID- 19 l\u00e0 H\u1ed9i ch\u1ee9ng Ho\u1ea1t H\u00f3a \u0110\u1ea1i Th\u1ef1c B\u00e0o (MAS\u2013Macrophage activation syndrome) \u2013 nh\u01b0 pha t\u0103ng \u0111\u00e1p \u1ee9ng vi\u00eam v\u1edbi c\u01a1n b\u00e3o cytokine v\u00e0 H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh (ARDS), th\u01b0\u1eddng trong v\u00f2ng 10-12 ng\u00e0y sau khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng. Nh\u00ecn chung, h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh (ARDS) \u1edf tr\u1ebb em kh\u00f3 x\u1ea3y ra h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn khi c\u00f3 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. Trong \u0111\u1ea1i d\u1ecbch c\u00fam H1N1 n\u0103m 2009, tr\u1ebb d\u01b0\u1edbi 1 tu\u1ed5i l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 quan tr\u1ecdng d\u1eabn \u0111\u1ebfn b\u1ec7nh n\u1eb7ng v\u00e0 ARDS (Bautista 2010<\/a>). V\u1eabn ch\u01b0a c\u00f3 l\u1eddi gi\u1ea3i th\u00edch r\u00f5 r\u00e0ng t\u1ea1i sao ARDS \u00edt ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf tr\u1ebb em so v\u1edbi ng\u01b0\u1eddi l\u1edbn khi m\u1eafc COVID.<\/p>\n

Li\u00ean quan \u0111\u1ebfn tr\u00ed nh\u1edb mi\u1ec5n d\u1ecbch, m\u1ed9t l\u1eddi gi\u1ea3i th\u00edch v\u1ec1 di\u1ec5n ti\u1ebfn b\u1ec7nh nh\u1eb9 \u1edf tr\u1ebb em c\u00f3 th\u1ec3 l\u00e0 do s\u1ef1 kh\u00e1c bi\u1ec7t li\u00ean quan \u0111\u1ebfn tu\u1ed5i t\u00e1c trong \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi SARS-CoV-2 gi\u1eefa ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em. V\u1eabn ch\u01b0a r\u00f5 li\u1ec7u m\u1ee9c \u0111\u1ed9 nhi\u1ec5m tr\u00f9ng tr\u01b0\u1edbc \u0111\u00f3 v\u1edbi c\u00e1c lo\u1ea1i virus corona kh\u00f4ng ph\u1ea3i SARS c\u00f3 t\u1ea1o ra c\u00e1c kh\u00e1ng th\u1ec3 b\u1ea3o v\u1ec7 ph\u1ea3n \u1ee9ng ch\u00e9o hay kh\u00f4ng.<\/p>\n

Trong ph\u1ea3n \u1ee9ng c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch b\u1ea9m sinh, c\u00e1c t\u1ebf b\u00e0o ph\u1ed5i b\u1ecb t\u1ed5n th\u01b0\u01a1ng do ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7a \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 b\u1ea1ch c\u1ea7u h\u1ea1t. D\u1ef1a tr\u00ean c\u00e1c m\u00f4 h\u00ecnh \u0111\u1ed9ng v\u1eadt v\u1ec1 b\u1ec7nh c\u00fam, \u0111\u00e3 c\u00f3 \u0111\u1ec1 xu\u1ea5t ti\u00eam vaccine BCG (\u0111\u01b0\u1ee3c ti\u00eam trong tu\u1ea7n \u0111\u1ea7u ti\u1ec1n sau sinh \u1edf m\u1ed9t s\u1ed1 qu\u1ed1c gia \u0111\u1ec3 ph\u00f2ng b\u1ec7nh Lao) c\u00f3 th\u1ec3 t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch b\u1ea9m sinh kh\u00f4ng \u0111\u1eb7c hi\u1ec7u \u1edf tr\u1ebb em \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng nh\u01b0 COVID- 19 (c\u0169ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 mi\u1ec5n d\u1ecbch \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n) (Moorlag 2019<\/a>). M\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a BCG World Atlas v\u00e0 m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi d\u1eef li\u1ec7u c\u00e1c ca m\u1eafc v\u00e0 t\u1eed vong do COVID-19 \u1edf m\u1ed7i qu\u1ed1c gia cho th\u1ea5y r\u1eb1ng c\u00e1c qu\u1ed1c gia kh\u00f4ng c\u00f3 ch\u00ednh s\u00e1ch ti\u00eam ch\u1ee7ng BCG \u0111\u1ea1i tr\u00e0 (\u00dd, H\u00e0 Lan, Hoa K\u1ef3) b\u1ecb \u1ea3nh h\u01b0\u1edfng n\u1eb7ng n\u1ec1 h\u01a1n so v\u1edbi c\u00e1c qu\u1ed1c gia c\u00f3 ch\u00ednh s\u00e1ch BCG l\u00e2u \u0111\u1eddi v\u00e0 \u0111\u1ea1i tr\u00e0, ti\u00eam ph\u00f2ng BCG c\u0169ng l\u00e0m gi\u1ea3m s\u1ed1 ca m\u1eafc COVID-19 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong m\u1ed9t qu\u1ed1c gia (Miller 2020, Hauer 2020<\/a>). D\u1eef li\u1ec7u g\u1ea7n \u0111\u00e2y t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn d\u1ef1a tr\u00ean qu\u1ea7n th\u1ec3 kh\u00f4ng cho th\u1ea5y s\u1ef1 gi\u1ea3m t\u1ef7 l\u1ec7 nhi\u1ec5m b\u1ec7nh \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh t\u1eeb 35 \u0111\u1ebfn 41 tu\u1ed5i \u1edf Israel \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u00eam v\u1eafc-xin BCG trong th\u1eddi th\u01a1 \u1ea5u so v\u1edbi nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng \u0111\u01b0\u1ee3c ti\u00eam v\u1eafc xin n\u00e0y. D\u1eef li\u1ec7u v\u1ec1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a ti\u00eam ph\u00f2ng BCG \u0111\u1ed1i v\u1edbi m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh COVID-19\u00a0 hi\u1ec7n v\u1eabn ch\u01b0a c\u00f3 (Hamiel 2020<\/a>).<\/p>\n

Trong \u0111\u00e1p \u1ee9ng th\u00edch nghi, t\u1ebf b\u00e0o T g\u00e2y \u0111\u1ed9c \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh ph\u1ea3n \u1ee9ng khi nhi\u1ec5m virus v\u00e0 ki\u1ec3m so\u00e1t s\u1ef1 nh\u00e2n l\u00ean c\u1ee7a ch\u00fang. Tr\u1ebb em c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i khi ch\u1ee9c n\u0103ng g\u00e2y \u0111\u1ed9c c\u1ee7a t\u1ebf b\u00e0o T CD8 trong nhi\u1ec5m virus \u1edf tr\u1ebb em c\u00f3 th\u1ec3 \u00edt g\u00e2y h\u1ea1i h\u01a1n so v\u1edbi ng\u01b0\u1eddi l\u1edbn. R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch v\u1edbi s\u1ef1 ti\u00eau hao c\u1ee7a c\u00e1c t\u1ebf b\u00e0o T \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf ng\u01b0\u1eddi l\u1edbn m\u1eafc COVID-19.\u00a0 Li\u00ean quan \u0111\u1ebfn mi\u1ec5n d\u1ecbch b\u1ea9m sinh, kh\u00e1ng th\u1ec3 IgM c\u1ee7a m\u1eb9 c\u00f3 th\u1ec3 truy\u1ec1n cho tr\u1ebb qua nhau thai v\u00e0\/ho\u1eb7c IgA qua s\u1eefa m\u1eb9. N\u1ebfu ng\u01b0\u1eddi m\u1eb9 ch\u01b0a t\u1eebng nhi\u1ec5m SARS-CoV-2 ho\u1eb7c b\u1ecb nhi\u1ec5m \u1edf cu\u1ed1i thai k\u00ec th\u00ec c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 s\u1ef1 truy\u1ec1n kh\u00e1ng th\u1ec3 SARS-CoV-2. \u1ede nh\u1eefng b\u00e0 m\u1eb9 m\u1eafc vi\u00eam ph\u1ed5i COVID-19, x\u00e9t nghi\u1ec7m SARS- CoV-2 cho tr\u1ebb t\u1eeb huy\u1ebft thanh v\u00e0 ph\u1ebft h\u1ecdng \u0111\u1ec1u cho k\u1ebft\u00a0 qu\u1ea3 \u00e2m t\u00ednh,\u00a0 tuy nhi\u00ean kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u IgG ch\u1ed1ng l\u1ea1i virus \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t\u00a0 hi\u1ec7n (Zeng H 2020<\/a>). Do \u0111\u00f3, tr\u1ebb s\u01a1 sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i khi c\u00e1c kh\u00e1ng th\u1ec3 \u0111\u1eb7c hi\u1ec7u v\u1edbi virus \u0111\u01b0\u1ee3c truy\u1ec1n qua nhau thai t\u1eeb ng\u01b0\u1eddi m\u1eb9 \u0111\u00e3 b\u1ecb ph\u01a1i nhi\u1ec5m. Gi\u1ed1ng v\u1edbi SARS CoV-1, m\u1ed9t \u0111\u1ee9a tr\u1ebb m\u1edbi nhi\u1ec5m SARS CoV-2 s\u1ebd t\u1ea1o ra ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch d\u1ecbch th\u1ec3 \u0111\u00e1ng k\u1ec3 c\u00f9ng v\u1edbi c\u00e1c kh\u00e1ng th\u1ec3 trung h\u00f2a IgM (trong v\u00e0i ng\u00e0y) v\u00e0 kh\u00e1ng th\u1ec3 IgG (trong v\u00f2ng 1-3 tu\u1ea7n) \u0111\u1ed1i v\u1edbi m\u1ed9t epitope (quy\u1ebft \u0111\u1ecbnh kh\u00e1ng nguy\u00ean) \u01b0u th\u1ec3, v\u00ed d\u1ee5 c\u00e1c protein gai h\u00ecnh v\u01b0\u01a1ng mi\u1ec7ng l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh t\u00ean c\u1ee7a m\u1ed7i lo\u1ea1i virus corona.<\/p>\n

D\u1eef li\u1ec7u v\u1ec1 m\u1ee9c \u0111\u1ed9 ph\u1ed5 bi\u1ebfn huy\u1ebft thanh IgG, IgM v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch \u1edf tr\u1ebb em v\u1eabn ch\u01b0a \u0111\u1ea7y \u0111\u1ee7. Ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 s\u1ef1 t\u00e1i nhi\u1ec5m \u1edf ng\u01b0\u1eddi v\u1edbi CoV-2 nh\u01b0ng nh\u00ecn chung, v\u1eabn ch\u01b0a r\u00f5 li\u1ec7u tr\u1ebb em c\u00f3 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch b\u1ec1n v\u1eefng v\u1edbi CoV-2 hay kh\u00f4ng?<\/p>\n

L\u00e2y nhi\u1ec5m<\/h2>\n

COVID-19 \u1edf ph\u1ee5 n\u1eef mang thai c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn thai nhi, c\u1ee5 th\u1ec3 l\u00e0 suy thai, nguy c\u01a1 sinh non ho\u1eb7c suy h\u00f4 h\u1ea5p n\u1ebfu ng\u01b0\u1eddi m\u1eb9 b\u1ecb b\u1ec7nh n\u1eb7ng. \u0110\u1ebfn nay v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y SARS-CoV-2 c\u00f3 th\u1ec3 truy\u1ec1n t\u1eeb m\u1eb9 sang con. X\u00e9t nghi\u1ec7m n\u01b0\u1edbc \u1ed1i, m\u00e1u d\u00e2y r\u1ed1n, ph\u1ebft h\u1ecdng \u1edf tr\u1ebb s\u01a1 sinh \u0111\u1ec1u cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 nh\u1ecf (Chen<\/a> 2020<\/a>). Schwartz \u0111\u00e3 \u0111\u00e1nh gi\u00e1 5 b\u00e0i b\u00e1o t\u1eeb Trung Qu\u1ed1c v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c 38 ph\u1ee5 n\u1eef mang thai v\u1edbi 39 tr\u1ebb, trong \u0111\u00f3 c\u00f3 30 tr\u1ebb \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m COVID-19 v\u00e0 t\u1ea5t c\u1ea3 \u0111\u1ec1u \u00e2m t\u00ednh (Schwartz 2020<\/a>). L\u00e2y truy\u1ec1n qua s\u1eefa m\u1eb9 ch\u01b0a \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u00e0 kh\u00f4ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p n\u00e0o ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c virus SARS- CoV-2 trong s\u1eefa m\u1eb9.<\/p>\n

SARS-CoV-2 \u1edf tr\u1ebb em l\u00e2y truy\u1ec1n qua c\u00e1c ti\u1ebfp x\u00fac v\u1edbi th\u00e0nh vi\u00ean trong gia \u0111\u00ecnh v\u00e0 ch\u1ee7 y\u1ebfu qua c\u00e1c gi\u1ecdt b\u1eafn. Trong m\u1ed9t nghi\u00ean c\u1ee9u t\u1ea1i Ph\u00e1p, b\u1ec7nh l\u00e2y truy\u1ec1n t\u1eeb tr\u1ebb sang tr\u1ebb v\u00e0 t\u1eeb tr\u1ebb sang ng\u01b0\u1eddi l\u1edbn d\u01b0\u1eddng nh\u01b0 kh\u00f4ng ph\u1ed5 bi\u1ebfn (Danis 2019<\/a>). Ph\u01a1i nhi\u1ec5m k\u00e9o d\u00e0i v\u1edbi n\u1ed3ng \u0111\u1ed9 kh\u00ed dung cao c\u00f3 th\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho s\u1ef1 l\u00e2y nhi\u1ec5m (She 2020<\/a>).<\/p>\n

SARS-CoV-2 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c truy\u1ec1n qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. ACE2 c\u0169ng \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c t\u1ebf b\u00e0o th\u1ef1c qu\u1ea3n v\u00e0 bi\u1ec3u m\u00f4 \u0111\u01b0\u1eddng ti\u00eau h\u00f3a tr\u00ean c\u0169ng nh\u01b0 c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ru\u1ed9t \u1edf h\u1ed3i tr\u00e0ng v\u00e0 \u0111\u1ea1i tr\u00e0ng (She 2020<\/a>). RNA c\u1ee7a SARS-CoV-2 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n trong ph\u00e2n c\u1ee7a b\u1ec7nh nh\u00e2n (Holshue 2020<\/a>). Cai cho r\u1eb1ng RNA c\u1ee7a virus \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf ph\u00e2n c\u1ee7a tr\u1ebb v\u1edbi t\u1ec9 l\u1ec7\u00a0 cao (v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft 2-4 tu\u1ea7n) (Cai 2020<\/a>). Tuy nhi\u00ean, v\u1eabn ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng tr\u1ef1c ti\u1ebfp ghi nh\u1eadn v\u1ec1 vi\u1ec7c l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng ph\u00e2n-mi\u1ec7ng.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i<\/h2>\n

Vi\u1ec7c x\u00e9t nghi\u1ec7m virus ch\u1ec9 c\u1ea7n thi\u1ebft \u1edf nh\u1eefng tr\u1ebb c\u00f3 nghi ng\u1edd v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng. N\u1ebfu k\u1ebft qu\u1ea3 ban \u0111\u1ea7u l\u00e0 \u00e2m t\u00ednh, n\u00ean l\u1eb7p l\u1ea1i x\u00e9t nghi\u1ec7m d\u1ecbch m\u0169i h\u1ecdng ho\u1eb7c ph\u1ebft h\u1ecdng c\u1ee7a m\u1eabu b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean ho\u1eb7c \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi. L\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi (kh\u1ea1c \u0111\u00e0m ho\u1eb7c r\u1eeda ph\u1ebf qu\u1ea3n) cho k\u1ebft qu\u1ea3 nh\u1ea1y h\u01a1n (Han 2020<\/a>). \u0110i\u1ec1u n\u00e0y kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 th\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng v\u00e0 \u1edf tr\u1ebb nh\u1ecf.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng ph\u1ea3n \u1ee9ng polymera-se khu\u1ebfch \u0111\u1ea1i gen b\u1eb1ng k\u1ef9 thu\u1eadt RT-PCR tr\u00ean d\u1ecbch ti\u1ebft \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. \u0110\u1ed1i v\u1edbi SARS-CoV, MERS-CoV v\u00e0 SARS-CoV-2, t\u1ea3i l\u01b0\u1ee3ng virus trong c\u00e1c m\u1eabu b\u1ec7nh ph\u1ea3m t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi cao h\u01a1n so v\u1edbi m\u1eabu t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean.<\/p>\n

\u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, SARS-CoV-2 RNA \u00e2m t\u00ednh trong c\u00e1c m\u1eabu b\u1ec7nh ph\u1ea9m \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, trong khi m\u1eabu ph\u00e2n v\u1eabn d\u01b0\u01a1ng t\u00ednh cho th\u1ea5y nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a do virus c\u00f3 th\u1ec3 k\u00e9o d\u00e0i\u00a0 ngay c\u1ea3 khi \u0111\u00e3 lo\u1ea1i b\u1ecf virus trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p (Xiao 2020<\/a>). Do \u0111\u00f3 x\u00e9t nghi\u1ec7m ph\u00e2n c\u00f3 th\u1ec3 c\u00f3 gi\u00e1 tr\u1ecb chu\u1ea9n \u0111o\u00e1n COVID-19 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n

Gi\u1ed1ng nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m virus kh\u00e1c, chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh CoV-2 IgM v\u00e0 IgG s\u1ebd xu\u1ea5t hi\u1ec7n sau v\u00e0i ng\u00e0y (IgM) \u0111\u1ebfn 1-3 tu\u1ea7n (IgG) sau khi nhi\u1ec5m b\u1ec7nh v\u00e0 n\u00f3 c\u00f3 ho\u1eb7c kh\u00f4ng th\u1ec3 ch\u1ec9 ra kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch b\u1ea3o v\u1ec7 (v\u1eabn \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh). \u0110i\u1ec1u th\u00fa v\u1ecb l\u00e0 chuy\u1ec3n \u0111\u1ed5i huy\u1ebft thanh kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u0111\u00e3 \u0111\u01b0a ra gi\u1ea3 thuy\u1ebft \u1edf m\u1ed9t s\u1ed1 \u00edt nh\u00e2n vi\u00ean y t\u1ebf (tu\u1ed5i trung b\u00ecnh 40) \u0111\u00e3 ph\u01a1i nhi\u1ec5m v\u1edbi m\u1ed9t \u0111\u1ee9a tr\u1ebb m\u1eafc COVID-19 t\u1ea1i m\u1ed9t \u0111\u01a1n v\u1ecb l\u1ecdc m\u00e1u nhi khoa (Hains 2020<\/a>).<\/p>\n

Huy\u1ebft thanh h\u1ecdc c\u00f3 th\u1ec3 h\u1eefu \u00edch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng g\u1ee3i \u00fd cao v\u1ec1 SARS-CoV-2 nh\u01b0ng \u00e2m t\u00ednh v\u1edbi x\u00e9t nghi\u1ec7m RNA, t\u1ee9c l\u00e0 \u1edf tr\u1ebb m\u1eafc H\u1ed9i Ch\u1ee9ng Vi\u00eam H\u1ec7 Th\u1ed1ng t\u1ea1m th\u1eddi li\u00ean quan \u0111\u1ebfn SARS-CoV (PIMS-TS). Trong tr\u01b0\u1eddng h\u1ee3p huy\u1ebft thanh h\u1ecdc c\u00f3 kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch b\u1ea3o v\u1ec7, \u0111i\u1ec1u n\u00e0y s\u1ebd c\u1ef1c k\u1ef3 quan tr\u1ecdng t\u1eeb quan \u0111i\u1ec3m y t\u1ebf c\u00f4ng c\u1ed9ng, v\u00ed d\u1ee5: \u0111i\u1ec1u n\u00e0y s\u1ebd cho ph\u00e9p \u0111\u1ed9i ng\u0169 chi\u1ebfn l\u01b0\u1ee3c trong ch\u0103m s\u00f3c y t\u1ebf v\u00e0 \u0111\u00e1nh gi\u00e1 d\u1ecbch t\u1ec5 h\u1ecdc CoV-2 (mi\u1ec5n d\u1ecbch c\u1ed9ng \u0111\u1ed3ng).<\/p>\n\n\n\n\n\n\n\n\n
B\u1ea3ng 1. <\/strong>Ph\u00e2n lo\u1ea1i COVID \u1edf tr\u1ebb em (Shen 2020)<\/a><\/td>\n<\/tr>\n
1<\/td>\nKh\u00f4ng tri\u1ec7u ch\u1ee9ng, kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng n\u00e0o<\/td>\n<\/tr>\n
2<\/td>\nS\u1ed1t nh\u1eb9, m\u1ec7t m\u1ecfi, \u0111au c\u01a1 v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh<\/td>\n<\/tr>\n
3<\/td>\nVi\u00eam ph\u1ed5i m\u1ee9c \u0111\u1ed9 trung b\u00ecnh, s\u1ed1t v\u00e0 ho, ho c\u00f3 \u0111\u00e0m, kh\u00f2 kh\u00e8, nh\u01b0ng kh\u00f4ng c\u00f3 h\u1ea1 oxy m\u00e1u<\/td>\n<\/tr>\n
4<\/td>\nS\u1ed1t cao, ho, th\u1edf nhanh, \u0111\u1ed9 b\u00e3o ho\u00e0 oxy d\u01b0\u1edbi 92%, l\u01a1 m\u01a1<\/td>\n<\/tr>\n
5<\/td>\nTi\u1ebfn tri\u1ec3n nhanh ch\u00f3ng nguy k\u1ecbch \u0111\u1ebfn h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ARDS ho\u1eb7c suy h\u00f4 h\u1ea5p<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc<\/strong><\/h3>\n

C\u00e1c nghi\u00ean c\u1ee9u kh\u00f4ng cho th\u1ea5y c\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 x\u00e9t nghi\u1ec7m v\u00e0\/ho\u1eb7c h\u00ecnh \u1ea3nh h\u1ecdc \u1edf tr\u1ebb m\u1eafc COVID-19 th\u1ec3 nh\u1eb9 ngo\u1ea1i tr\u00fa. L\u00fac nh\u1eadp vi\u1ec7n, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u th\u01b0\u1eddng l\u00e0 b\u00ecnh th\u01b0\u1eddng. \u1ede m\u1ed9t s\u1ed1 \u00edt tr\u1ebb em, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u lympho gi\u1ea3m \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Ng\u01b0\u1ee3c l\u1ea1i, ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh (v\u1edbi ph\u1ea3n \u1ee9ng vi\u00eam qu\u00e1 m\u1ee9c v\u00e0 b\u00e3o cytokine) th\u01b0\u1eddng c\u00f3 s\u1ef1 gia t\u0103ng b\u1ea1ch c\u1ea7u trung t\u00ednh v\u00e0 gi\u1ea3m t\u1ebf b\u00e0o lympho. \u1ede m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n, c\u00e1c th\u00f4ng s\u1ed1 v\u1ec1 t\u00ecnh tr\u1ea1ng vi\u00eam nh\u01b0 CRP v\u00e0 Procalcitonin c\u00f3 th\u1ec3 t\u0103ng nh\u1eb9 ho\u1eb7c b\u00ecnh th\u01b0\u1eddng, trong khi \u0111\u00f3 t\u0103ng men gan, CK-MB v\u00e0 D-dimer \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. LDH d\u01b0\u1eddng nh\u01b0 s\u1ebd t\u0103ng trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u1eb7ng v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 theo d\u00f5i di\u1ec5n ti\u1ebfn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n

X-quang ng\u1ef1c ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf tr\u1ebb em m\u1eafc b\u1ec7nh th\u1ec3 v\u1eeba ho\u1eb7c n\u1eb7ng v\u00ec ch\u1ee5p CT g\u00e2y ra nhi\u1ec5m x\u1ea1 r\u1ea5t cao v\u00e0 ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ebfn ch\u1ee9ng ho\u1eb7c c\u00f3 nguy c\u01a1 cao. Trong giai \u0111o\u1ea1n \u0111\u1ea7u d\u1ecbch b\u1ec7nh \u1edf Trung Qu\u1ed1c, t\u1ea5t c\u1ea3 tr\u1ebb em \u0111\u1ec1u \u0111\u01b0\u1ee3c ch\u1ee5p CT ngay c\u1ea3 khi ch\u00fang ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng tho\u00e1ng qua ho\u1eb7c th\u1eadm ch\u00ed kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng; nh\u01b0ng \u0111\u00e1ng ng\u1ea1c nhi\u00ean l\u00e0, \u0111i\u1ec1u n\u00e0y \u0111\u00e3 ph\u00e1t hi\u1ec7n nh\u1eefng thay \u0111\u1ed5i l\u1edbn. Tr\u00ean X quang ng\u1ef1c c\u00f3 h\u00ecnh \u1ea3nh c\u00e1c \u0111\u1ed1m m\u1edd \u0111\u00f4ng \u0111\u1eb7c r\u1ea3i r\u00e1c \u1edf hai ph\u1ebf tr\u01b0\u1eddng v\u00e0 h\u00ecnh \u1ea3nh k\u00ednh m\u1edd (ground-glass opacities). Ch\u1ee5p CT cho k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n so v\u1edbi X-quang ng\u1ef1c. Trong 20 tr\u1ebb ch\u1ee5p CT, 16 (80%) tr\u1ebb c\u00f3 m\u1ed9t s\u1ed1 h\u00ecnh \u1ea3nh b\u1ea5t th\u01b0\u1eddng (Xia 2020<\/a>).<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/h3>\n

Tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean<\/strong><\/h4>\n

Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh c\u00f3 v\u1ebb t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00fam. Trong th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u1edbn nh\u1ea5t v\u1edbi 171 tr\u1ebb \u1edf V\u0169 H\u00e1n, t\u1ec9 l\u1ec7 s\u1ed1t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 41% (71 tr\u00ean 171 tr\u1ebb), ho tr\u00ean 50% (83 tr\u00ean 171 tr\u1ebb), th\u1edf nhanh \u1edf 28% (49 tr\u00ean 171 tr\u1ebb). V\u00e0 c\u00f3 \u0111\u1ebfn 27 tr\u1ebb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00e0o (15,8%). T\u1ea1i th\u1eddi \u0111i\u1ec3m th\u0103m kh\u00e1m ban \u0111\u1ea7u, r\u1ea5t \u00edt tr\u1ebb c\u1ea7n ph\u1ea3i b\u1ed5 sung oxy (4 trong 171 tr\u1ebb, 2,3%). C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c nh\u01b0 ti\u00eau ch\u1ea3y, m\u1ec7t m\u1ecfi, s\u1ed5 m\u0169i v\u00e0 n\u00f4n c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi t\u1ec9 l\u1ec7 d\u01b0\u1edbi 10% (Lu 2020<\/a>). Trong m\u1ed9t b\u00e1o c\u00e1o h\u00e0ng lo\u1ea1t ca b\u1ec7nh \u1edf Chi\u1ebft Giang, c\u00f3 \u0111\u1ebfn 10 tr\u00ean 36 (28%) b\u1ec7nh nhi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00e0o c\u1ea3. Kh\u00f4ng c\u00f3 tr\u1ebb n\u00e0o c\u00f3 \u0111\u1ed9 b\u00e3o h\u00f2a oxy d\u01b0\u1edbi 92% (Qiu 2020<\/a>).<\/p>\n

Tr\u1ebb s\u01a1 sinh v\u00e0 nh\u0169 nhi<\/strong><\/h4>\n

Zeng b\u00e1o c\u00e1o 33 tr\u1ebb s\u01a1 sinh c\u00f3 m\u1eb9 b\u1ecb nhi\u1ec5m COVID-19 t\u1ea1i V\u0169 H\u00e1n. Ba trong s\u1ed1 33 tr\u1ebb s\u01a1 sinh (9%) nhi\u1ec5m SARS-CoV-2 kh\u1edfi ph\u00e1t s\u1edbm. Trong 3 tr\u1ebb n\u00e0y, c\u00f3 2 tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc. Khi b\u00e1o c\u00e1o \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 (ng\u00e0y 26\/03\/2020), m\u1ed9t tr\u1ebb \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 b\u1ecb \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa nh\u01b0ng cu\u1ed1i c\u00f9ng t\u1ea5t c\u1ea3 \u0111\u1ec1u c\u00f3 d\u1ea5u hi\u1ec7u sinh t\u1ed3n \u1ed5n \u0111\u1ecbnh sau 3 tu\u1ea7n nhi\u1ec5m\u00a0 b\u1ec7nh (Zeng L 020). Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 th\u1ee9 hai, 9 tr\u1ebb s\u01a1 sinh t\u1eeb 1 \u0111\u1ebfn 9 th\u00e1ng tu\u1ed5i \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 kh\u00f4ng c\u00f3 b\u1ea5t k\u1ef3 bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng n\u00e0o (Wei 2020). Li\u1ec7u c\u00f3 bi\u1ebfn ch\u1ee9ng d\u00e0i h\u1ea1n do COVID-19 \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 nh\u0169 nhi hay kh\u00f4ng? T\u1ea1i th\u1eddi \u0111i\u1ec3m n\u00e0y, ch\u00fang ta ch\u01b0a th\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c. Hi\u1ec7n t\u1ea1i, kh\u00f4ng n\u00ean t\u00e1ch tr\u1ebb m\u1edbi sinh kh\u1ecfe m\u1ea1nh kh\u1ecfi c\u00e1c b\u00e0 m\u1eb9 nghi nhi\u1ec5m COVID-19 (CDC-2 2020). R\u00f5 r\u00e0ng tr\u1ebb sinh non ho\u1eb7c tr\u1ebb s\u01a1 sinh \u0111\u00e3 ph\u01a1i nhi\u1ec5m v\u1edbi SARS-CoV-2 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i k\u1ef9 c\u00e0ng t\u1ea1i b\u1ec7nh vi\u1ec7n v\u00e0\/ho\u1eb7c b\u00e1c s\u0129 nhi khoa. N\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u COVID (v\u00ed d\u1ee5: \u0103n k\u00e9m, nhi\u1ec7t \u0111\u1ed9 kh\u00f4ng \u1ed5n \u0111\u1ecbnh, nh\u1ecbp tim nhanh\/kh\u00f3 th\u1edf) c\u1ea7n ph\u1ea3i nh\u1eadp vi\u1ec7n, l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ee5p X-quang ng\u1ef1c. X\u00e9t nghi\u1ec7m t\u00ecm SARS-CoV-2 kh\u00f4ng c\u00f3 \u00edch tr\u01b0\u1edbc ng\u00e0y th\u1ee9 5 c\u1ee7a b\u1ec7nh v\u00ec c\u00f2n trong giai \u0111o\u1ea1n \u1ee7 b\u1ec7nh. C\u1ea7n ph\u1ea3i gi\u1eef v\u1ec7 sinh t\u1ed1t nh\u1ea5t c\u00f3 th\u1ec3 cho c\u1ea3 m\u1eb9 v\u00e0 con.<\/p>\n

H\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 \u1edf tr\u1ebb em li\u00ean quan t\u1ea1m th\u1eddi v\u1edbi SARS-CoV-2 (PIMS-TS) (ho\u1eb7c h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 \u1edf tr\u1ebb em (MIS-C) ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng t\u01b0\u1ee3ng t\u1ef1 b\u1ec7nh Kawasaki<\/strong><\/p>\n

\"Vi\u00eam<\/p>\n

Th\u00e1ng 4 n\u0103m 2020, c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng h\u1ecdc t\u1eeb Anh, Ph\u00e1p, \u00dd, T\u00e2y Ban Nha v\u00e0 Hoa K\u1ef3 \u0111\u00e3 b\u00e1o c\u00e1o v\u1ec1 c\u00e1c tr\u1ebb em m\u1eafc h\u1ed9i ch\u1ee9ng vi\u00eam n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng b\u1ec7nh gi\u1ed1ng b\u1ec7nh Kawasaki, m\u1ed9t s\u1ed1 tr\u1ebb c\u00f3 k\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh v\u1edbi CoV-2, s\u1ed1 c\u00f2n l\u1ea1i th\u00ec kh\u00f4ng. Tr\u01b0\u1edbc \u0111\u00f3, Jones \u0111\u00e3 m\u00f4 t\u1ea3 m\u1ed9t tr\u01b0\u1eddng h\u1ee3p v\u1ec1 b\u00e9 g\u00e1i 6 th\u00e1ng tu\u1ed5i b\u1ecb s\u1ed1t, ph\u00e1t ban v\u00e0 s\u01b0ng n\u1ec1 \u0111\u1eb7c tr\u01b0ng c\u1ee7a m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam nhi\u1ec5m hi\u1ebfm g\u1eb7p \u1edf tr\u1ebb em, h\u1ed9i ch\u1ee9ng Kawasaki (Jones 2020<\/a>).<\/p>\n

T\u00e1m b\u1ec7nh nh\u00e2n \u1edf Anh v\u00e0 10 b\u1ec7nh nh\u00e2n \u1edf Bergamo, \u00dd c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh Kawasaki \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, bao g\u1ed3m c\u1ea3 tr\u01b0\u1eddng h\u1ee3p t\u1eed vong c\u1ee7a c\u1eadu b\u00e9 14 tu\u1ed5i t\u1ea1i Anh trong \u0111\u1ea1i d\u1ecbch SARS-CoV-2 (Riphagen 2020<\/a>, Verdoni 2020<\/a>).\u00a0 \u1ede Bergamo, khu v\u1ef1c c\u00f3 t\u1ef7 l\u1ec7 l\u00e2y nhi\u1ec5m cao nh\u1ea5t \u1edf \u00dd, t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh gi\u1ed1ng Kawasaki t\u0103ng kho\u1ea3ng 30 l\u1ea7n \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong \u0111\u1ea1i d\u1ecbch SARS-CoV-2 (Verdoni 2020<\/a>).<\/p>\n

Hi\u1ec7n t\u1ea1i, m\u1ed1i li\u00ean quan v\u1ec1 sinh l\u00fd b\u1ec7nh gi\u1eefa vi\u00eam nhi\u1ec5m do COVID-19 v\u00e0 b\u1ec7nh Kawasaki v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng, c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong B\u1ea3ng 2.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
B\u1ea3ng 2. <\/strong>C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh Kawasaki v\u00e0 h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb em li\u00ean quan t\u1ea1m th\u1eddi v\u1edbi nhi\u1ec5m SARS-CoV-2<\/td>\n<\/tr>\n
<\/td>\nKawasaki <\/strong>(Hedrich 2017, ECDC 2020<\/a>) (tr\u01b0\u1edbc \u0111\u00e2y g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng h\u1ea1ch b\u1ea1ch huy\u1ebft ni\u00eam m\u1ea1c)<\/td>\nPIMS-TS<\/strong> (h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 \u1edf tr\u1ebb em li\u00ean quan t\u1ea1m th\u1eddi v\u1edbi SARS-CoV-2 ho\u1eb7c MIS-C<\/strong> (h\u1ed9i ch\u1ee9ng vi\u00eam \u0111a h\u1ec7 \u1edf tr\u1ebb em) (Verdoni 2020<\/a>; Riphagen 2020<\/a>, https:\/\/covid19-surveillance-report.ecdc.europa.eu\/<\/a>)<\/p>\n

\u201cB\u1ec7nh gi\u1ed1ng b\u1ec7nh Kawasaki\u201d<\/strong><\/td>\n<\/tr>\n

D\u1ecbch t\u1ec5 h\u1ecdc<\/td>\nT\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc 5-19\/100.000 < 5 tu\u1ed5i (Ch\u00e2u \u00c2u, Hoa K\u1ef3), \u1edf \u0110\u00f4ng B\u1eafc \u00c1 cao h\u01a1n, c\u00f3 s\u1ef1 gia t\u0103ng theo m\u00f9a, m\u00f9a \u0111\u00f4ng\/m\u00f9a xu\u00e2n, \u0111\u1ecba l\u00fd, l\u00e0n s\u00f3ng l\u00e2y lan theo \u0111\u1ecba l\u00fd c\u1ee7a d\u1ecbch b\u1ec7nh\u00a0\u00a0 (Rowley 2018<\/a>)<\/td>\nT\u1ef7 l\u1ec7 hi\u1ec7n m\u1eafc ch\u01b0a r\u00f5.<\/p>\n

230 tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd li\u00ean quan t\u1ea1m th\u1eddi \u0111\u1ebfn COVID-19 \u0111\u00e3 b\u00e1o c\u00e1o v\u1edbi ECDC tr\u01b0\u1edbc ng\u00e0y 15 th\u00e1ng 5 (EU\/EEA, Anh). Ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ng\u01b0\u1eddi d\u00e2n g\u1ed1c Afro-caribbean, b\u00e9o ph\u00ec? (Riphagen 2020<\/a>)<\/td>\n<\/tr>\n

Tu\u1ed5i, gi\u1edbi<\/td>\nTr\u1ebb d\u01b0\u1edbi 5 tu\u1ed5i chi\u1ebfm 90%, cao h\u01a1n \u1edf nam gi\u1edbi<\/td>\n5-15 tu\u1ed5i, ch\u01b0a r\u00f5 s\u1ef1 ph\u00e2n b\u1ed1 gi\u1edbi t\u00ednh<\/td>\n<\/tr>\n
Nguy\u00ean nh\u00e2n<\/td>\nCh\u01b0a r\u00f5, gi\u1ea3 thuy\u1ebft: nhi\u1ec5m tr\u00f9ng c\u00e1c m\u1ea7m b\u1ec7nh ph\u1ed5 bi\u1ebfn, v\u00ed d\u1ee5 nh\u01b0 vi khu\u1ea9n, n\u1ea5m v\u00e0 virus g\u00e2y t\u1ed5n th\u01b0\u01a1ng qua trung gian mi\u1ec5n d\u1ecbch (Dietz 2017<\/a>) (Jordan-Villegas 2010<\/a>, Kim 2012<\/a>, Turnier 2015<\/a>). Y\u1ebfu t\u1ed1 di truy\u1ec1n (t\u1ea7n s\u1ed1 t\u0103ng \u1edf Ch\u00e2u \u00c1 v\u00e0 gi\u1eefa c\u00e1c th\u00e0nh vi\u00ean gia \u0111\u00ecnh c\u1ee7a 1 ca b\u1ec7nh)<\/td>\nCh\u01b0a r\u00f5, ch\u01b0a c\u00f3 gi\u1ea3 thuy\u1ebft.<\/p>\n

Vi\u00eam qu\u00e1 m\u1ee9c ho\u1eb7c s\u1ed1c li\u00ean quan \u0111\u1ebfn \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi SARS-CoV-2. T\u0103ng c\u01b0\u1eddng b\u1ec7nh l\u00fd ph\u1ee5 thu\u1ed9c kh\u00e1ng th\u1ec3 (ADE) CoV-1: s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a kh\u00e1ng th\u1ec3 c\u00f3 th\u1ec3 g\u00e2y b\u1ea5t l\u1ee3i, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho virus l\u00e2y lan (ch\u1ee9ng minh trong SARS-CoV)<\/td>\n<\/tr>\n

\u0110\u1ecbnh ngh\u0129a ca b\u1ec7nh<\/p>\n

 <\/td>\n

S\u1ed1t \u22655 ng\u00e0y, k\u1ebft h\u1ee3p \u00edt nh\u1ea5t 4 trong 5 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng sau:<\/p>\n

1.Vi\u00eam \u0111\u1ecf k\u1ebft m\u1ea1c 2 b\u00ean<\/p>\n

2. Bi\u1ebfn \u0111\u1ed5i m\u00e0ng nh\u1ea7y \u1edf mi\u1ec7ng, bao g\u1ed3m m\u00f4i b\u1ecb ti\u00eam ho\u1eb7c n\u1ee9t n\u1ebb, h\u1ea7u h\u1ecdng b\u1ecb ti\u00eam, ho\u1eb7c l\u01b0\u1ee1i \u0111\u1ecf d\u00e2u.<\/p>\n

3. Thay \u0111\u1ed5i \u1edf \u0111\u1ea7u chi, bao g\u1ed3m ban \u0111\u1ecf \u1edf l\u00f2ng b\u00e0n tay ho\u1eb7c ch\u00e2n, ph\u00f9 b\u00e0n tay, b\u00e0n ch\u00e2n (giai \u0111o\u1ea1n c\u1ea5p) ho\u1eb7c bong da xung quanh (giai \u0111o\u1ea1n h\u1ed3i ph\u1ee5c)<\/p>\n

4. Ban \u0111\u1ecf \u0111a d\u1ea1ng to\u00e0n th\u00e2n<\/p>\n

5. S\u01b0ng h\u1ea1ch c\u1ed5 kh\u00f4ng h\u00f3a m\u1ee7 (McCrindle 2017<\/a>)<\/p>\n

Tr\u1ebb nghi ng\u1edd m\u1eafc KD\u00a0 (Kawasaki disease) nh\u01b0ng kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 m\u1eafc KD d\u1ea1ng kh\u00f4ng ho\u00e0n to\u00e0n ho\u1eb7c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (Cimaz 2009<\/a>)<\/td>\n

1. S\u1ed1t dai d\u1eb3ng, vi\u00eam (b\u1ea1ch c\u1ea7u trung t\u00ednh, CRP t\u0103ng v\u00e0 gi\u1ea3m t\u1ebf b\u00e0o lympho), v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng m\u1ed9t ho\u1eb7c nhi\u1ec1u c\u01a1 quan (s\u1ed1c, tim, h\u00f4 h\u1ea5p, th\u1eadn, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a ho\u1eb7c th\u1ea7n kinh) v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng ho\u1eb7c h\u00ecnh \u1ea3nh v\u00e0 ECG. Tr\u1ebb em c\u00f3 \u0111\u1ea9y \u0111\u1ee7 ho\u1eb7c m\u1ed9t ph\u1ea7n c\u00e1c ti\u00eau ch\u00ed c\u1ee7a b\u1ec7nh Kawasaki c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c bao g\u1ed3m.<\/p>\n

2. Lo\u1ea1i tr\u1eeb b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n vi khu\u1ea9n n\u00e0o kh\u00e1c, bao g\u1ed3m nhi\u1ec5m tr\u00f9ng huy\u1ebft do vi khu\u1ea9n, h\u1ed9i ch\u1ee9ng s\u1ed1c t\u1ee5 c\u1ea7u ho\u1eb7c li\u00ean c\u1ea7u, nhi\u1ec5m tr\u00f9ng li\u00ean quan \u0111\u1ebfn vi\u00eam c\u01a1 tim nh\u01b0 enterovirus<\/p>\n

3. X\u00e9t nghi\u1ec7m PCR SARS-CoV-2 d\u01b0\u01a1ng t\u00ednh ho\u1eb7c \u00e2m t\u00ednh (Royal College of Paediatrics and Child Health)<\/td>\n<\/tr>\n

T\u00ecnh tr\u1ea1ng CoV-2 trong \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p<\/td>\nCoV-2 Ag (PCR); Abs (Elisa) \u00e2m t\u00ednh<\/td>\nCoV-2 Ag (PCR) \u00e2m t\u00ednh v\u00e0 Abs (Elisa) d\u01b0\u01a1ng t\u00ednh<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m \u0111i\u1ec3n h\u00ecnh<\/td>\n\u0110\u00e1nh d\u1ea5u s\u1ef1 t\u0103ng l\u00ean c\u1ee7a c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng pha c\u1ea5p (v\u00ed d\u1ee5, protein ph\u1ea3n \u1ee9ng C [CRP] ho\u1eb7c t\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u [ESR]\n

T\u0103ng ti\u1ec3u c\u1ea7u (sau ng\u00e0y th\u1ee9 7 c\u1ee7a b\u1ec7nh)<\/p>\n

T\u0103ng b\u1ea1ch c\u1ea7u, chuy\u1ec3n tr\u00e1i (b\u1ea1ch c\u1ea7u trung t\u00ednh t\u0103ng)<\/td>\n

\u0110\u00e1nh d\u1ea5u s\u1ef1 t\u0103ng l\u00ean c\u1ee7a c\u00e1c ch\u1ea5t ph\u1ea3n \u1ee9ng pha c\u1ea5p CRP, ESR<\/p>\n

Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/p>\n

Gi\u1ea3m b\u1ea1ch c\u1ea7u<\/p>\n

Gi\u1ea3m t\u1ebf b\u00e0o lympho<\/p>\n

T\u0103ng cholesterol m\u00e1u<\/p>\n

C\u00e1c ch\u1ec9 \u0111i\u1ec3m vi\u00eam c\u01a1 tim t\u0103ng Troponin, pro-BNP<\/td>\n<\/tr>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ea5p t\u00ednh<\/td>\nH\u1ed9i ch\u1ee9ng s\u1ed1c Kawasaki (KDSS) (hi\u1ebfm), \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a h\u1ed9i ch\u1ee9ng ho\u1ea1t h\u00f3a \u0111\u1ea1i th\u1ef1c b\u00e0o (MAS) (hi\u1ebfm), b\u1ea5t th\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, h\u1edf van hai l\u00e1, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 tim ti\u1ebfn tri\u1ec3n, \u0111\u00f4ng m\u00e1u r\u1ea3i r\u00e1c trong l\u00f2ng m\u1ea1ch (Kanegaye 2009<\/a>)<\/p>\n

Bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (vi\u00eam ru\u1ed9t, n\u00f4n \u0111au b\u1ee5ng) hi\u1ebfm g\u1eb7p<\/td>\n

S\u1ed1c (ph\u1ed5 bi\u1ebfn), \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a h\u1ed9i ch\u1ee9ng ho\u1ea1t h\u00f3a \u0111\u1ea1i th\u1ef1c b\u00e0o (ph\u1ed5 bi\u1ebfn), li\u00ean quan \u0111\u1ebfn c\u01a1 tim \u0111\u01b0\u1ee3c ch\u1ee9ng minh b\u1edfi s\u1ef1 t\u0103ng l\u00ean c\u1ee7a c\u00e1c\u00a0 enzym tim t\u0103ng (ph\u1ed5 bi\u1ebfn), nh\u1ed3i m\u00e1u c\u01a1 tim, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch, \u0111\u00f4ng m\u00e1u n\u1ed9i m\u1ea1ch lan t\u1ecfa<\/p>\n

Bi\u1ebfn ch\u1ee9ng \u0111\u01b0\u1eddng ti\u00eau h\u00f3a (vi\u00eam ru\u1ed9t, n\u00f4n, \u0111au b\u1ee5ng) r\u1ea5t ph\u1ed5 bi\u1ebfn<\/td>\n<\/tr>\n

Bi\u1ebfn ch\u1ee9ng m\u00e3n t\u00ednh<\/td>\nB\u1ea5t th\u01b0\u1eddng \u0111\u1ed9ng m\u1ea1ch (ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh trung b\u00ecnh, ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh kh\u1ed5ng l\u1ed3 CAAs)<\/td>\nCh\u01b0a x\u00e1c \u0111\u1ecbnh; ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch?<\/td>\n<\/tr>\n
Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n<\/td>\n\u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u b\u1eb1ng Immunoglobulin ti\u00eam t\u0129nh m\u1ea1ch li\u1ec1u cao (IVIG) (2g\/kg); c\u00f3 \u00edch trong vi\u1ec7c gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh khi d\u00f9ng trong 10 ng\u00e0y k\u1ec3 t\u1eeb khi ph\u00e1t s\u1ed1t. Ngo\u00e0i ra, axit acetylsalicylic, glucocorticoid v\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng anti-TNF \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng<\/td>\nCho \u0111\u1ebfn nay, h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng IVIG li\u1ec1u cao, glucocorticoids, ASS (Verdoni 2020<\/a>, Riphagen 2020<\/a>)<\/p>\n

\u0110i\u1ec1u tr\u1ecb kh\u00e1ng IVIG k\u00e8m Steroid r\u1ea5t ph\u1ed5 bi\u1ebfn (Verdoni 2020<\/a>)<\/p>\n

Ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c nhi khoa l\u00e0 c\u1ea7n thi\u1ebft: ti\u1ebfn tri\u1ec3n \u0111\u1ebfn s\u1ed1c m\u1ea1ch m\u00e1u l\u00e0 ph\u1ed5i bi\u1ec3n<\/p>\n

H\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng noradrenaline v\u00e0 milrinone, th\u01b0\u1eddng ph\u1ea3i th\u1edf m\u00e1y (Riphagen 2020<\/a>)<\/td>\n<\/tr>\n

Ti\u00ean l\u01b0\u1ee3ng<\/td>\nVi\u00eam m\u1ea1ch t\u1ef1 gi\u1edbi h\u1ea1n k\u00e9o d\u00e0i trung b\u00ecnh 12 ng\u00e0y m\u00e0 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb. N\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, CAAs v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 ch\u1ee9ng ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf 25% tr\u1ebb em<\/td>\nTi\u00ean l\u01b0\u1ee3ng chung ch\u01b0a r\u00f5 r\u00e0ng.<\/p>\n

N\u1eb7ng h\u01a1n KD<\/p>\n

C\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed v\u1ecdng trong m\u1ed9t s\u1ed1 ca b\u1ec7nh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n<\/h2>\n

Ki\u1ec3m so\u00e1t nhi\u1ec5m tr\u00f9ng<\/strong><\/h3>\n

Ph\u00e1t hi\u1ec7n s\u1edbm COVID-19 v\u00e0 b\u1eaft bu\u1ed9c th\u1ef1c hi\u1ec7n c\u00e1ch ly. Trong m\u00f4i tr\u01b0\u1eddng n\u1ed9i tr\u00fa v\u00e0 ngo\u1ea1i tr\u00fa, n\u00ean t\u00e1ch ri\u00eang tr\u1ebb em m\u1eafc b\u1ec7nh truy\u1ec1n nhi\u1ec5m kh\u1ecfi tr\u1ebb em kh\u1ecfe m\u1ea1nh kh\u00f4ng m\u1eafc b\u1ec7nh. C\u00e1c \u1ed5 d\u1ecbch t\u1ea1i b\u1ec7nh vi\u1ec7n c\u00f3 vai tr\u00f2 trong s\u1ef1 l\u00e2y truy\u1ec1n COVID-19. Do \u0111\u00f3, ch\u1ec9 n\u00ean cho tr\u1ebb m\u1eafc COVID-19 nh\u1eadp vi\u1ec7n n\u1ebfu b\u00e1c s\u0129 nhi khoa c\u00f3 kinh nghi\u1ec7m c\u1ea3m th\u1ea5y c\u1ea7n thi\u1ebft (v\u00ed d\u1ee5 nh\u01b0 th\u1edf nhanh, kh\u00f3 th\u1edf, m\u1ee9c b\u00e3o h\u00f2a oxy d\u01b0\u1edbi 92%). T\u1ea1i b\u1ec7nh vi\u1ec7n, tr\u1ebb m\u1eafc COVID-19 ho\u1eb7c nghi ng\u1edd m\u1eafc c\u1ea7n \u0111\u01b0\u1ee3c c\u00e1ch ly trong ph\u00f2ng ri\u00eang ho\u1eb7c chuy\u1ec3n v\u00e0o m\u1ed9t khoa ri\u00eang bi\u1ec7t d\u00e0nh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb COVID-19 v\u1edbi c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf chuy\u00ean bi\u1ec7t cho khoa n\u00e0y (v\u00ed d\u1ee5 kh\u00f4ng l\u00e0m vi\u1ec7c\/kh\u00f4ng tr\u1ef1c th\u00eam \u1edf c\u00e1c khoa kh\u00e1c). C\u1ea7n thi\u1ebft c\u00f3 s\u1ef1 c\u00f3 m\u1eb7t c\u1ee7a ph\u1ee5 huynh trong vi\u1ec7c ch\u0103m s\u00f3c tr\u1ebb b\u1ecb b\u1ec7nh, c\u1ea3 v\u1ec1 t\u00ecnh c\u1ea3m c\u0169ng nh\u01b0 nu\u00f4i d\u01b0\u1ee1ng tr\u1ebb.<\/p>\n

Trong giai \u0111o\u1ea1n \u0111\u1ec9nh \u0111i\u1ec3m c\u1ee7a \u0111\u1ea1i d\u1ecbch COVID-19, c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba trong m\u00f4i tr\u01b0\u1eddng ngo\u1ea1i tr\u00fa v\u00e0 b\u1ec7nh vi\u1ec7n bao g\u1ed3m ki\u1ec3m so\u00e1t l\u1ed1i v\u00e0o, v\u1ec7 sinh tay v\u00e0 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea9n th\u1eadn, v\u1ec7 sinh v\u00e0 kh\u1eed tr\u00f9ng m\u00f4i tr\u01b0\u1eddng l\u00e0m vi\u1ec7c h\u00e0ng ng\u00e0y, v\u00e0 cung c\u1ea5p \u0111\u1ed3 b\u1ea3o h\u1ed9 (g\u0103ng tay, kh\u1ea9u trang, k\u00ednh b\u1ea3o h\u1ed9) cho m\u1ecdi nh\u00e2n vi\u00ean y t\u1ebf ch\u0103m s\u00f3c cho b\u1ec7nh nh\u00e2n COVID-19 ho\u1eb7c nghi ng\u1edd m\u1eafc COVID-19 (Wang 2020<\/a>). Trong c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c tr\u1ebb s\u01a1 sinh (NICU), l\u00fd t\u01b0\u1edfng c\u1ea7n c\u00f3 ph\u00f2ng c\u00e1ch ly \u00e1p l\u1ef1c \u00e2m v\u00e0 l\u1ecdc kh\u00f4ng kh\u00ed (Lu Q 2020<\/a>). N\u00ean s\u1eed d\u1ee5ng m\u1eb7t n\u1ea1 c\u00f3 h\u1ec7 th\u1ed1ng tu\u1ea7n ho\u00e0n v\u00e0 b\u1ed9 l\u1ecdc k\u00edn. C\u00e1c th\u1ee7 thu\u1eadt t\u1ea1o ra kh\u00ed dung, v\u00ed d\u1ee5 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, n\u1ed9i soi ph\u1ebf qu\u1ea3n, phun kh\u00ed dung n\u00ean h\u1ea1n ch\u1ebf c\u00e0ng \u00edt c\u00e0ng t\u1ed1t<\/p>\n

\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 (h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p, \u0111i\u1ec1u tr\u1ecb gi\u00e3n ph\u1ebf qu\u1ea3n, s\u1ed1t, b\u1ed9i nhi\u1ec5m, h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd x\u00e3 h\u1ed9i)<\/strong><\/h3>\n

Cho tr\u1ebb ng\u1ed3i \u1edf t\u01b0 th\u1ebf th\u1eb3ng \u0111\u1ee9ng s\u1ebd gi\u00fap tr\u1ebb d\u1ec5 th\u1edf h\u01a1n. V\u1eadt l\u00fd tr\u1ecb li\u1ec7u s\u1ebd r\u1ea5t h\u1eefu \u00edch trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y. Cung c\u1ea5p oxy qua \u1ed1ng th\u00f4ng m\u0169i s\u1ebd r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi tr\u1ebb v\u00ec n\u00f3 s\u1ebd l\u00e0m t\u0103ng th\u00f4ng kh\u00ed v\u00e0 t\u01b0\u1edbi m\u00e1u ph\u1ed5i. Th\u1edf oxy l\u01b0u l\u01b0\u1ee3ng cao qua \u1ed1ng th\u00f4ng m\u0169i \u1edf tr\u1ebb s\u01a1 sinh (HFNC) \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i do t\u00ednh \u01b0u vi\u1ec7t c\u1ee7a n\u00f3 so v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p kh\u00f4ng x\u00e2m l\u1ea5n kh\u00e1c.<\/p>\n

Ch\u01b0a r\u00f5 r\u00e0ng v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng v\u00e0 t\u00ednh an to\u00e0n c\u1ee7a c\u00e1c thu\u1ed1c d\u1ea1ng h\u00edt tr\u00ean l\u00e2m s\u00e0ng. Trong b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh v\u00e0 nhi\u1ec5m tr\u00f9ng th\u00f4ng th\u01b0\u1eddng kh\u00e1c \u1edf tr\u1ebb em, v\u00ed d\u1ee5: trong vi\u00eam ph\u1ebf qu\u1ea3n, Vi\u1ec7n H\u00e0n l\u00e2m Nhi khoa Hoa K\u1ef3 hi\u1ec7n \u0111ang khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n (Dunn 2020). Li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c steroids d\u1ea1ng h\u00edt nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a \u0111i\u1ec1u tr\u1ecb duy tr\u00ec trong hen ph\u1ebf qu\u1ea3n, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o bu\u1ed9c ph\u1ea3i ng\u1eebng c\u00e1ch \u0111i\u1ec1u tr\u1ecb n\u00e0y cho tr\u1ebb em m\u1eafc COVID-19.<\/p>\n

M\u1ed9t cu\u1ed9c tranh c\u00e3i l\u1edbn x\u1ea3y ra v\u1ec1 m\u1ee9c \u0111\u1ed9 s\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 s\u1ed1t \u1edf tr\u1ebb em. Nh\u01b0ng n\u1ebfu tr\u1ebb m\u1eafc COVID-19 b\u1ecb s\u1ed1t cao, paraceta- mol ho\u1eb7c ibuprofen c\u00f3 th\u1ec3 c\u00f3 \u00edch. Kh\u00f4ng h\u1ea1n ch\u1ebf n\u00e0o, m\u1eb7c d\u00f9 ban \u0111\u1ea7u WHO c\u1ea3nh b\u00e1o v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng ibuprofen, tuy nhi\u00ean hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng paracetamol ho\u1eb7c ibuprofen g\u00e2y h\u1ea1i \u1edf tr\u1ebb em m\u1eafc COVID-19 (Day 2020<\/a>).<\/p>\n

Vi\u1ec7c ph\u00e2n bi\u1ec7t vi\u00eam ph\u1ed5i do virus SARS-CoV-2 v\u1edbi b\u1ed9i nhi\u1ec5m vi khu\u1ea9n s\u1ebd kh\u00f3 kh\u0103n tr\u1eeb khi c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng t\u1eeb k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y ho\u1eb7c c\u00e1c h\u00ecnh \u1ea3nh \u0111i\u1ec3n h\u00ecnh. B\u1ed9i nhi\u1ec5m vi khu\u1ea9n s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a qu\u1ed1c t\u1ebf v\u00e0 qu\u1ed1c gia (Mathur 2018).<\/p>\n

D\u1ecbch b\u1ec7nh virus g\u00e2y c\u0103ng th\u1eb3ng t\u00e2m l\u00fd cho cha m\u1eb9 v\u00e0 gia \u0111\u00ecnh c\u0169ng nh\u01b0 nh\u00e2n vi\u00ean y t\u1ebf, do \u0111\u00f3, c\u00e1c nh\u00e2n vi\u00ean c\u00f4ng t\u00e1c x\u00e3 h\u1ed9i v\u00e0 c\u00e1c nh\u00e0 t\u00e2m l\u00fd h\u1ecdc n\u00ean tham gia h\u1ed7 tr\u1ee3 ngay khi c\u00f3 th\u1ec3.<\/p>\n

\u0110i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p<\/strong><\/h3>\n

\u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh \u1edf tr\u1ebb em (pARDS) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 (Allareddy 2019<\/a>). V\u1edbi nh\u1eefng tr\u1ebb s\u01a1 sinh c\u00f3 pARDS th\u00ec vi\u1ec7c thay th\u1ebf surfactant ph\u1ed5i li\u1ec1u cao, th\u1edf kh\u00ed NO, v\u00e0 th\u00f4ng kh\u00ed t\u1ea7n s\u1ed1 cao c\u00f3 th\u1ec3 \u0111em l\u1ea1i hi\u1ec7u qu\u1ea3. \u1ede nh\u1eefng tr\u1ebb s\u01a1 sinh m\u1eafc b\u1ec7nh n\u1eb7ng, l\u1ecdc m\u00e1u li\u00ean t\u1ee5c v\u00e0 oxy h\u00f3a qua m\u00e0ng ngo\u00e0i c\u01a1 th\u1ebf (ECMO) c\u1ea7n \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n n\u1ebfu c\u1ea7n thi\u1ebft.<\/p>\n

Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u COVID-19<\/strong><\/h3>\n

Cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a c\u00f3 d\u1eef li\u1ec7u t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u00f3 \u0111\u1ed1i ch\u1ee9ng, v\u00ec v\u1eady hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 s\u1eb5n b\u1eb1ng ch\u1ee9ng \u0111\u00e1ng tin c\u1eady n\u00e0o h\u1ed7 tr\u1ee3 cho vi\u1ec7c s\u1eed d\u1ee5ng b\u1ea5t k\u1ef3 lo\u1ea1i thu\u1ed1c n\u00e0o \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb COVID-19. C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea d\u01b0\u1edbi \u0111\u00e2y l\u00e0 c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed5i m\u1ee5c \u0111\u00edch s\u1eed d\u1ee5ng v\u00e0 c\u00f3 r\u1ea5t \u00edt ho\u1eb7c h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 kinh nghi\u1ec7m d\u00f9ng tr\u00ean tr\u1ebb em. Trong tr\u01b0\u1eddng h\u1ee3p tr\u1ebb b\u1ecb COVID-19 n\u1eb7ng ho\u1eb7c nguy k\u1ecbch, b\u00e1c s\u0129 nhi khoa ph\u1ea3i \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh c\u00f3 n\u00ean d\u00f9ng thu\u1ed1c n\u00e0y hay kh\u00f4ng. N\u1ebfu quy\u1ebft \u0111\u1ecbnh b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c, tr\u1ebb n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (https:\/\/www.clinicaltrialsregister.eu<\/a>) n\u1ebfu c\u00f3 th\u1ec3. Tuy nhi\u00ean, r\u1ea5t \u00edt c\u00e1c nghi\u00ean c\u1ee9u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u00ean tr\u1ebb em.<\/p>\n

Khi n\u00e0o \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c<\/strong><\/h4>\n

D\u01b0\u1edbi s\u1ef1 ch\u1ec9 \u0111\u1ea1o c\u1ee7a Hi\u1ec7p h\u1ed9i Truy\u1ec1n Nhi\u1ec5m Nhi \u1edf \u0110\u1ee9c (DGPI), m\u1ed9t h\u1ed9i \u0111\u1ed3ng chuy\u00ean gia \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t m\u1ed9t \u0111\u1ed3ng thu\u1eadn v\u1ec1 th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ng virus ho\u1eb7c thu\u1ed1c \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch \u1edf tr\u1ebb em. (B\u1ea3ng 3,<\/p>\n

https:\/\/dgpi.de\/stellungnahme-<\/a>medikamentoese-behandlung-von-kindern-mit-covid-19\/).<\/a><\/p>\n

M\u1ed9t nh\u00f3m c\u00e1c b\u00e1c s\u0129 truy\u1ec1n nhi\u1ec5m nhi khoa v\u00e0 d\u01b0\u1ee3c s\u0129 t\u1eeb c\u00e1c vi\u1ec7n B\u1eafc M\u1ef9 \u0111\u00e3 c\u00f4ng b\u1ed1 m\u1ed9t h\u01b0\u1edbng d\u1eabn v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng virus cho tr\u1ebb nhi\u1ec5m SARS. N\u00ean h\u1ea1n ch\u1ebf \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p kh\u00e1ng virus cho tr\u1ebb m\u00e0 c\u00f3 kh\u1ea3 n\u0103ng mang l\u1ea1i l\u1ee3i \u00edch cao h\u01a1n nguy c\u01a1 nhi\u1ec5m \u0111\u1ed9c v\u00e0 remdesvir l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng (Chiotos 2020<\/a>).<\/p>\n

C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p RNA c\u1ee7a virus<\/strong><\/h4>\n

Remdesivir (GS-5734) <\/strong>c\u00f3 s\u1eb5n d\u01b0\u1edbi d\u1ea1ng l\u1ecd 150 mg. Li\u1ec1u d\u00f9ng cho tr\u1ebb em l\u00e0:<\/p>\n