DOI: https://doi.org/10.14710/nmjn.v12i3.45340

Non-comorbid Respiratory Factor and Work of Breathing in Pediatric COVID-19 Patient: How is Their Synergistic Correlation with the Level of Care?

*Defi Efendi orcid scopus  -  Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Maria Dyah Kurniasari orcid  -  Department of Nursing, Faculty of Medicine and Health Science, Universitas Kristen Satya Wacana, Indonesia
Mega Hasanul Huda  -  Institut Kesehatan Prima Nusantara Bukittinggi, Indonesia
Raudha Ilmi Farid  -  Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Indonesia
Yohanes Andy Rias  -  Faculty of Health and Medicine, Institut Ilmu Kesehatan Bhakti Wiyata Kediri, Indonesia
Yogi Prawira  -  Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
Nina Dwi Putri  -  Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Indonesia
Ayuni Rizka Utami orcid  -  Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Titik Ambar Asmarini orcid  -  Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Pande Lilik Lestari  -  Sanglah National Hospital, Indonesia
Pricilia Mais  -  Prof. dr. R. D. Kandou National Hospital, Indonesia
Abram Babakal  -  Prof. dr. R. D. Kandou National Hospital, Indonesia
Open Access Copyright (c) 2022 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Work of breathing (WOB) and non-comorbidities factors in the respiratory system are the two probable findings in pediatric COVID-19 patients. However, the association of those factors with level of care was not well reported.

Purpose: This study aimed to identify the relation between potential predictors including comorbidity, low nutritional fulfillment, infectious disease, shock, cough, O2 saturation reduction, abnormal blood gas analysis and sore throat with the level of care among pediatric COVID-19 patients. We also analyzed the synergistic correlation of non-comorbidities factors in the respiratory system and work of breathing to predict level of care in pediatric COVID-19 patients.

Methods: A cross-sectional study was conducted in the six referral hospitals from July to September 2020 in four provinces in Indonesia. An observation checklist was used to collect data from the medical records of pediatric patients with COVID-19, including medical diagnosis, demographic, and clinical manifestation. This study included 423 participants aged from 0 to 18. The multivariate logistic regression was performed to test the adjusted odds ratios (AORs) with the 95% confidence intervals (CIs) of the association between WOB, non-comorbid respiratory, and level of care. Moreover, dummy variables (2x2) were made to analyze synergistic correlation of non-comorbid respiratory disease and WOB. The AOR with the 95% CIs was applied in the association between the complication of non-comorbid respiratory diseases and high work of breathing with level of care among pediatric patients with COVID-19.

Results: Results showed that age, presence of comorbidity, nutritional fulfillment, infectious disease, shock, work of breathing, O2 saturation reduction, abnormal blood gas analysis, sore throat, and convulsive meningeal consciousness were significantly associated with the level of care (p<0.05). Pediatric patients with non-comorbid respiratory and increased work of breathing had a 15.59 times higher risk of requiring PICU care level (p<0.01). Meanwhile, pediatric patients who experienced both non-comorbid respiratory and increased work of breathing had a 5.76 times risk of requiring an intermediate level of care (p<0.05), and 9.32 times higher risk of requiring a PICU level of care (p<.05).

Conclusion: It was found that both non-comorbid respiratory and increased WOB had a significant relationship with the level of care for pediatric patients with COVID-19. Nurse should take into account those clinical findings to increase the awareness in monitoring clinical deterioration in pediatric COVID-19 patients.
Fulltext View|Download
Keywords: COVID-19; level-of-care; non-comorbid respiratory; pediatric intensive care unit; WOB
Funding: Faculty of Nursing Universitas Indonesia under contract NKB/UN.2.F12.D/HKP.01.03/2020

Article Metrics:

Article Info
Section: Articles
Language : EN
Recent articles
“A life without a supervisor is like a seed that never grows”: Students’ Experiences of Undergraduate Nursing Research Supervision Triggers of Workplace Violence in Emergency Departments: A Qualitative Study Individual Characteristics, Adherence, and Barriers to Medication Adherence of Hypertensive Patients at the Indonesia - Timor Leste Border Editorial Back Matter Editorial Front Matter More recent articles
Most cited articles
EFFECTIVENESS OF MUSIC THERAPY TOWARD REDUCING PATIENT’S ANXIETY IN INTENSIVE CARE UNIT The Quality of Life of Women with Cervical Cancer in Indonesia: A Cross-Sectional Study Music and Music Intervention for Therapeutic Purposes in Patients with Ventilator Support; Gamelan Music Perspective The Lived Experiences of the Lombok Earthquake Survivors Social Support and Coping of Indonesian Family Caregivers Caring for Persons with Schizophrenia More cited articles
  1. Apigo, M., Schechtman, J., Dhliwayo, N., Al Tameemi, M., & Gazmuri, R. J. (2020). Development of a work of breathing scale and monitoring need of intubation in COVID-19 pneumonia. Critical Care, 24(1), 4–6. https://doi.org/10.1186/s13054-020-03176-y
  2. Bellino, S., Punzo, O., Rota, M. C., Del Manso, M., Urdiales, A. M., Andrianou, X., Fabiani, M., Boros, S., Vescio, F., Riccardo, F., Bella, A., Filia, A., Rezza, G., Villani, A., & Pezzotti, P. (2020). COVID-19 Disease severity risk factors for pediatric patients in Italy. Pediatrics, 146(4), e2020009399. https://doi.org/10.1542/peds.2020-009399
  3. Buonsenso, D., Parri, N., De Rose, C., Valentini, P., & Gemelli-pediatric COVID-19 team (2021). Toward a clinically based classification of disease severity for paediatric COVID-19. The Lancet. Infectious diseases, 21(1), 22. https://doi.org/10.1016/S1473-3099(20)30396-0
  4. Cai, X., Ma, Y., Li, S., Chen, Y., Rong, Z., & Li, W. (2020). Clinical characteristics of 5 COVID-19 cases with non-respiratory symptoms as the first manifestation in children. Frontiers in Pediatrics, 8, 258. https://doi.org/10.3389/fped.2020.00258
  5. Carlotti, P., Carvalho, A. P. de, Carvalho, D., Brunow, W., Johnston, Rodriguez, C., Souza, I., Delgado, & Figueiredo, A. (2020). COVID-19 diagnostic and management protocol for pediatric patients. Clinics, 75, 1–5. https://doi.org/10.6061/CLINICS/2020/E1894
  6. CDC. (2020). Coronavirus disease. People with certain medical conditions. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  7. Chang, T. H., Wu, J. L., & Chang, L. Y. (2020). Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis. Journal of the Formosan Medical Association, 119(5), 982–989. https://doi.org/10.1016/j.jfma.2020.04.007
  8. Chen, A. P. L., Chuang, C., Huang, Y. C., Wu, P. F., Huang, S. F., Cheng, N. C., Lin, Y. T., Chen, S. J., Huang, L. J., Lee, C. L., Chen, H. P., Chan, Y. J., & Wang, F. Der. (2021). The epidemiology and etiologies of respiratory tract infection in Northern Taiwan during the early phase of coronavirus disease 2019 (COVID-19) outbreak. Journal of Microbiology, Immunology and Infection, 54(5), 801–807. https://doi.org/10.1016/j.jmii.2021.05.006
  9. Chen, Z. M., Fu, J. F., Shu, Q., Chen, Y. H., Hua, C. Z., Li, F. B., Lin, R., Tang, L. F., Wang, T. L., Wang, W., Wang, Y. S., Xu, W. Z., Yang, Z. H., Ye, S., Yuan, T. M., Zhang, C. M., & Zhang, Y. Y. (2020). Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World Journal of Pediatrics, 16(3), 240–246. https://doi.org/10.1007/s12519-020-00345-5
  10. Choi, S. H., Kim, H. W., Kang, J. M., Kim, D. H., & Cho, E. Y. (2020). Epidemiology and clinical features of coronavirus disease 2019 in children. Clinical and experimental pediatrics, 63(4), 125–132. https://doi.org/10.3345/cep.2020.00535
  11. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates
  12. de Souza, T. H., Nadal, J. A., Nogueira, R. J. N., Pereira, R. M., & Brandão, M. B. (2020). Clinical manifestations of children with COVID-19: A systematic review. Pediatric Pulmonology, 55(8), 1892–1899. https://doi.org/10.1002/ppul.24885
  13. Derespina, K. R., Kaushik, S., Plichta, A., Conway, E. E., Jr, Bercow, A., Choi, J., Eisenberg, R., Gillen, J., Sen, A. I., Hennigan, C. M., Zerihun, L. M., Doymaz, S., Keenaghan, M. A., Jarrin, S., Oulds, F., Gupta, M., Pierre, L., Grageda, M., Ushay, H. M., Nadkarni, V. M., … Medar, S. S. (2020). Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City. The Journal of pediatrics, 226, 55–63. https://doi.org/10.1016/j.jpeds.2020.07.039
  14. Dong, Y., Mo, X., Hu, Y., Qi, X., Jiang, F., & Jiang, Z. (2020). Epidemiology of COVID-19 Among Children in China. Pediatrics, 145(6), 1-10. https://doi.org/https://doi.org/10.1542/peds.2020-0702
  15. El Maniani, M., Rechchach, M., El Mahfoudi, A., El Moudane, M., & Sabbar, A. (2016). A Calorimetric investigation of the liquid bi-ni alloys. Journal of Materials and Environmental Science, 7(10), 3759–3766. https://doi.org/10.1021/j150541a003
  16. Garland, A., Ashton-Cleary, D., & Sinclair, R. (2016). Inpatient illness severity surveys provide essential data for planning capacity and managing patient flow in the acute hospital setting. Journal of the Intensive Care Society, 17(3), 196–201. https://doi.org/10.1177/1751143716628884
  17. Girona-Alarcon, M., Bobillo-Perez, S., Sole-Ribalta, A., Hernandez, L., Guitart, C., Suarez, R., Balaguer, M., Cambra, F. J., & Jordan, I. (2021). The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit. BMC Infectious Diseases, 21(1), 4–11. https://doi.org/10.1186/s12879-021-05786-5
  18. Götzinger, F., Santiago-García, B., Noguera-Julián, A., Lanaspa, M., Lancella, L., Calò Carducci, F. I., Gabrovska, N., Velizarova, S., Prunk, P., Osterman, V., Krivec, U., Lo Vecchio, A., Shingadia, D., Soriano-Arandes, A., Melendo, S., Lanari, M., Pierantoni, L., Wagner, N., L’Huillier, A. G., … Riordan, A. (2020). COVID-19 in children and adolescents in Europe: A multinational, multicentre cohort study. The Lancet Child and Adolescent Health, 4(9), 653–661. https://doi.org/10.1016/S2352-4642(20)30177-2
  19. Graff, K., Smith, C., Silveira, L., Jung, S., Curran-Hays, S., Jarjour, J., Carpenter, L., Pickard, K., Mattiucci, M., Fresia, J., McFarland, E. J., Dominguez, S. R., & Abuogi, L. (2021). Risk Factors for Severe COVID-19 in Children. Pediatric Infectious Disease Journal, 40(4), E137–E145. https://doi.org/10.1097/INF.0000000000003043
  20. Gulbech Ording, A., & Toft Sørensen, H. (2013). Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clinical Epidemiology, 5(1), 199–203. https://doi.org/10.2147/CLEP.S45305
  21. Gupta, S., Angurana, S. K., & Kumar, V. (2021). Respiratory Care in Children with COVID-19. Journal of Pediatric Intensive Care. 10(4), 1-8. https://doi.org/10.1055/s-0041-1723036
  22. Hoang, Ansel & Chorath, Kevin & Moreira, Axel & Evans, Mary & Burmeister-Morton, Finn & Burmeister Mccracken, Fiona & Naqvi, Rija & Petershack, Matthew & Moreira, Alvaro. (2020). COVID-19 in 7780 pediatric patients: A systematic review. E-Clinical Medicine. 24. 100433. https://doi.org/10.1016/j.eclinm.2020.100433
  23. Hong, H., Wang, Y., Chung, H., & Chen, C. (2020). Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns , infants and children. Pediatrics and Neonatology, 61(2), 131–132. https://doi.org/10.1016/j.pedneo.2020.03.001
  24. Hopman, J., Allegranzi, B., & Mehtar, S. (2020). Managing COVID-19 in Low- and Middle-Income Countries _ Enhanced Reader.pdf. JAMA. 323(16), 1549–1550
  25. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
  26. Jain, S., Sen, S., Lakshmivenkateshiah, S., Bobhate, P., Venkatesh, S., Udani, S., Shobhavat, L., Andankar, P., Karande, T., & Kulkarni, S. (2020). Multisystem inflammatory syndrome in children with COVID-19 in Mumbai, India. Indian Pediatrics, 57, 1015–1019. https://doi.org/10.1016/j.ajem.2021.05.076
  27. Knol, M. J., Tweel, I. Van Der, Grobbee, D. E., & Numans, M. E. (2007). Estimating interaction on an additive scale between continuous determinants in a logistic regression model. International Journal of Epidemiology, 36, 1111–1118. https://doi.org/10.1093/ije/dym157
  28. Kouame, J. B. (2010). Using readability tests to improve the accuracy of evaluation documents intended for low-literate participants. Journal of MultiDisciplinary Evaluation, 6(14), 132–139. http://journals.sfu.ca/jmde/index.php/jmde_1/article/viewFile/280/283
  29. Kurniasari, M. D., Karwur, F. F., Rayanti, R. E., Dharmana, E., Rias, Y. A., Chou, K. R., & Tsai, H.-T. (2021). Second-hand smoke and its synergistic effect with a body-mass index of >24.9 kg/m2 increase the risk of gout arthritis in Indonesia. International Journal of Environmental Research and Public Health, 18(8), 4324. https://doi.org/10.3390/ijerph18084324
  30. Lee, J. H., Rehder, K. J., Williford, L., Cheifetz, I. M., & Turner, D. A. (2013). Use of high flow nasal cannula in critically ill infants, children, and adults: A critical review of the literature. Intensive Care Medicine, 39(2), 247–257. https://doi.org/10.1007/s00134-012-2743-5
  31. Marin, B.G., Aghagoli, G., Lavine, K., Yang, L., Siff, E. J., Chiang, S. S., Salazar-Mather, T. P., Dumenco, L., Savaria, M. C., Aung, S. N., Flanigan, T., & Michelow, I. C. (2021). Predictors of COVID-19 severity: A literature review. Reviews in Medical Virology, 31(1), 1–10. https://doi.org/10.1002/rmv.2146
  32. Mostafa, A. S., Abdalbaky, A., Fouda, E. M., Shaaban, H. H., Elnady, H. G., Hassab-Allah, M., Rashad, M. M., El Attar, M. M., Alfishawy, M., Hussien, S. M., Hamed, T., Hamed, D. H., & Sarhan, D. T. (2020). Practical approach to COVID-19: An Egyptian pediatric consensus. Egyptian Pediatric Association Gazette, 68(1), 1-8. https://doi.org/10.1186/s43054-020-00037-9
  33. Muñoz, I. C., Hernández, A. M., & Mañanas, M. Á. (2019). Estimation of work of breathing from respiratory muscle activity in spontaneous ventilation: A pilot study. Applied Sciences (Switzerland), 9(10), 1-18. https://doi.org/10.3390/app9102007
  34. Pathak, E. B., Salemi, J. L., Sobers, N., Menard, J., & Hambleton, I. R. (2020). Covid-19 in children in the united states: Intensive care admissions, estimated total infected, and projected numbers of severe pediatric cases in 2020. Journal of Public Health Management and Practice, 26(4), 325–333. https://doi.org/10.1097/PHH.0000000000001190
  35. Prata-Barbosa, A., Lima-Setta, F., Santos, G. R. dos, Lanziotti, V. S., de Castro, R. E. V., de Souza, D. C., Raymundo, C. E., de Oliveira, F. R. C., de Lima, L. F. P., Tonial, C. T., Colleti, J., Bellinat, A. P. N., Lorenzo, V. B., Zeitel, R. de S., Pulcheri, L., Costa, F. C. M. da, La Torre, F. P. F., Figueiredo, E. A. das N., Silva, T. P. da, … de Magalhães-Barbosa, M. C. (2020). Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. Jornal de Pediatria, 96(5), 582–592. https://doi.org/10.1016/j.jped.2020.07.002
  36. Roser, M., Ritchie, H., Ortiz-Ospina, E., & Hasell, J. (2020). Coronavirus (COVID-19) cases - statistics and research - our world in data. In our world in data (Vol. 2020, pp. 1–42)
  37. Sankar, J., Dhochak, N. S., Kabra, S. ., & Lodha, R. (2020). COVID-19 in children: Clinical approach and management-correspondence. Indian Journal of Pediatrics, 87(11), 970–972. https://doi.org/10.1007/s12098-020-03374-0
  38. Sanyaolu, A., Okorie, C., Marinkovic, A., Patidar, R., Younis, K., Desai, P., Hosein, Z., Padda, I., Mangat, J., & Altaf, M. (2020). Comorbidity and its impact on patients with COVID-19. Comprehensive Clinical Medicine, 2(8), 1069–1076. https://doi.org/10.1007/s42399-020-00363-4
  39. Shekerdemian, L. S., Mahmood, N. R., Wolfe, K. K., Riggs, B. J., Ross, C. E., McKiernan, C. A., Heidemann, S. M., Kleinman, L. C., Sen, A. I., Hall, M. W., Priestley, M. A., McGuire, J. K., Boukas, K., Sharron, M. P., & Burns, J. P. (2020). Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatrics, 174(9), 868–873. https://doi.org/10.1001/jamapediatrics.2020.1948
  40. Soltani, J., Sedighi, I., Shalchi, Z., Sami, G., Moradveisi, B., & Nahidi, S. (2020). Pediatric coronavirus disease 2019 (COVID-19): An insight from west of Iran. Northern Clinics of Istanbul, 7(3), 284–291. https://doi.org/10.14744/nci.2020.90277
  41. Sun, M., Xu, G., Yang, Y., Tao, Y., Pian-Smith, M., Madhavan, V., Xie, Z., & Zhang, J. (2020). Evidence of mother-to-newborn infection with COVID-19. British Journal of Anaesthesia, 125(2), e245–e247. https://doi.org/10.1016/j.bja.2020.04.066
  42. Swann, O. V., Holden, K. A., Turtle, L., Pollock, L., Fairfield, C. J., Drake, T. M., Seth, S., Egan, C., Hardwick, H. E., Halpin, S., Girvan, M., Donohue, C., Pritchard, M., Patel, L. B., Ladhani, S., Sigfrid, L., Sinha, I. P., Olliaro, P. L., Nguyen-Van-Tam, J. S., … Semple, M. G. (2020). Clinical characteristics of children and young people admitted to hospital with COVID-19 in United Kingdom: Prospective multicentre observational cohort study. The BMJ, 370(M3249). 1-14. https://doi.org/10.1136/bmj.m3249
  43. Talarico, V., Nicoletti, A., Sabetta, L., Minchella, P., & Raiola, G. (2020). Preliminary epidemiological analysis on children and adolescents with novel coronavirus disease (2019-ncov) in acentral area of Calabria region. Acta Biomedica, 91(2), 232–233. https://doi.org/10.23750/abm.v91i2.9550
  44. Task Force for the Acceleration of Handling COVID-19. (2020). COVID-19 infographic (26 October 2020). https://covid19.go.id/id/peta-sebaran
  45. The National Health and Health Commission of, & China, P. R. of. (2020). Diagnosis and treatment guidelines for 2019 novel coronavirus pneumonia (draft version 5). http://www.nhc.gov.cn/yzygj/s76%0A53p/202002/3b09b894ac9b4204a79db5b89%0A12d4440.shtml
  46. Tsankov, B. K., Allaire, J. M., Irvine, M. A., Lopez, A. A., Sauvé, L. J., Vallance, B. A., & Jacobson, K. (2021). Severe COVID-19 infection and pediatric comorbidities: A systematic review and meta-analysis. International Journal of Infectious Diseases, 103, 246–256. https://doi.org/10.1016/j.ijid.2020.11.163
  47. Tulaimat, A., Gueret, R. M., Wisniewski, M. F., & Samuel, J. (2014). Association between rating of respiratory distress and vital signs, severity of Illness, intubation, and mortality in acutely 111 subjects. Respiratory Care, 59(9), 1338–1344. https://doi.org/10.4187/respcare.02650
  48. World Health Organization (WHO). (2020a). Public health surveillance for COVID-19. Interim guidance. 7 August 2020 (Issue August, pp. 1–10). https://doi.org/10.1007/978-1-59745-326-4_13
  49. World Health Organization (WHO). (2020b). WHO Coronavirus Disease (COVID-19) dashboard. https://covid19.who.int/
  50. Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, 8(5), 475–481. https://doi.org/10.1016/S2213-2600(20)30079-5
  51. Zhang, N., Deng, Y., Li, W., Liu, J., Li, H., Liu, E., & Zheng, X. (2020). Analysis and suggestions for the preview and triage screening of children with suspected COVID-19 outside the epidemic area of Hubei Province. Translational Pediatrics, 9(2), 126–132. https://doi.org/10.21037/tp.2020.03.08
  52. Zhou, Y., He, Y., Yang, H., Yu, H., Wang, T., Chen, Z., Id, R. Y., & Liang, Z. (2020). Development and validation a nomogram for predicting the risk of severe COVID- 19 : A multi-center study in Sichuan , China. PloS One, 863, 1–14. https://doi.org/10.1371/journal.pone.0233328
  53. Zimmermann, P., & Curtis, N. (2020). Coronavirus infections in children including COVID-19. An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. The Pediatric Infectious Disease Journal, 39(5), 355–368. https://doi.org/10.1097/INF.0000000000002660

Last update:

  1. Perception of COVID-19 Vaccination Based on Health Belief Model and the Acceptance of COVID-19 Booster Vaccination

    Risma Arlyani Dewi, Jon Hafan Sutawardana, Ana Nistiandani. Nurse Media Journal of Nursing, 13 (1), 2023. doi: 10.14710/nmjn.v13i1.47694

Last update: 2023-09-27 19:57:09

No citation recorded.