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      Clinical presentations and outcome of severe acute respiratory syndrome in children

      , FAAP a , , FRCPCH d , , MRCPCH a , , MD b , , FRCR c , , MRCP d , , MRCP a , , MRCP d , , MD a , , FRCP d , , MD d , , PhD b , , Prof, MD a , *

      Lancet (London, England)

      Elsevier Ltd.

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          Summary

          Hong Kong has been severely affected by severe acute respiratory syndrome (SARS). Contact in households and healthcare settings is thought to be important for transmission, putting children at particular risk. Most data so far, however, have been for adults. We prospectively followed up the first ten children with SARS managed during the early phase of the epidemic in Hong Kong. All the children had been in close contact with infected adults. Persistent fever, cough, progressive radiographic changes of chest and lymphopenia were noted in all patients. The children were treated with high-dose ribavirin, oral prednisolone, or intravenous methylprednisolone, with no short-term adverse effects. Four teenagers required oxygen therapy and two needed assisted ventilation. None of the younger children required oxygen supplementation. Compared with adults and teenagers, SARS seems to have a less aggressive clinical course in younger children.

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          A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection.

          Although the antiviral agent ribavirin improves the course of lower respiratory tract disease in spontaneously breathing infants with respiratory syncytial virus infection, it is not known whether ribavirin can benefit infants with severe respiratory syncytial virus disease who require mechanical ventilation. We conducted a randomized, double-blind, placebo-controlled evaluation of ribavirin (20 mg per milliliter) administered continuously in aerosolized form to infants receiving mechanical ventilation for respiratory failure that was caused by documented respiratory syncytial virus infection. Of the 28 infants (mean [+/- SD] age, 1.4 +/- 1.7 months) enrolled, 7 had underlying diseases predisposing them to severe infection (mean age, 3.0 +/- 2.6 months), and 21 were previously normal (mean age, 0.8 +/- 0.9 month). Among the 14 infants who received ribavirin, the mean duration of mechanical ventilation was 4.9 days (as compared with 9.9 days among the 14 who received placebo; P = 0.01), and the mean length of supplemental oxygen use was 8.7 days (as compared with 13.5 days; P = 0.01). The mean length of the hospital stay was 13.3 days after treatment with ribavirin and 15.0 with placebo (P = 0.04). When only the 21 previously normal infants were considered, the mean length of the hospital stay was 9.0 days for the ribavirin recipients and 15.3 days for those who received placebo (P = 0.005). In infants who require mechanical ventilation because of severe respiratory syncytial virus infection, treatment with aerosolized ribavirin decreases the duration of mechanical ventilation, oxygen treatment, and the hospital stay.
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            Author and article information

            Contributors
            Journal
            Lancet
            Lancet
            Lancet (London, England)
            Elsevier Ltd.
            0140-6736
            1474-547X
            15 May 2003
            17 May 2003
            15 May 2003
            : 361
            : 9370
            : 1701-1703
            Affiliations
            [a ]Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China
            [b ]Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China
            [c ]Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China
            [d ]Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
            Author notes
            [* ]Correspondence to: Prof T F Fok, Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, Special Administrative Region, China taifaifok@ 123456cuhk.edu.hk
            Article
            S0140-6736(03)13364-8
            10.1016/S0140-6736(03)13364-8
            7112484
            12767737
            Copyright © 2003 Elsevier Ltd. All rights reserved.

            Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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