Neurosurgery in an infant with COVID-19
Identifieur interne : 000496 ( Pmc/Corpus ); précédent : 000495; suivant : 000497Neurosurgery in an infant with COVID-19
Auteurs : Giorgio Carrabba ; Leonardo Tariciotti ; Sophie Guez ; Edoardo Calderini ; Marco LocatelliSource :
- Lancet (London, England) [ 0140-6736 ] ; 2020.
Url:
DOI: 10.1016/S0140-6736(20)30927-2
PubMed: 32333840
PubMed Central: 7176389
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PMC:7176389Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Neurosurgery in an infant with COVID-19</title><author><name sortKey="Carrabba, Giorgio" sort="Carrabba, Giorgio" uniqKey="Carrabba G" first="Giorgio" last="Carrabba">Giorgio Carrabba</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Tariciotti, Leonardo" sort="Tariciotti, Leonardo" uniqKey="Tariciotti L" first="Leonardo" last="Tariciotti">Leonardo Tariciotti</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Guez, Sophie" sort="Guez, Sophie" uniqKey="Guez S" first="Sophie" last="Guez">Sophie Guez</name><affiliation><nlm:aff id="aff3">Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Calderini, Edoardo" sort="Calderini, Edoardo" uniqKey="Calderini E" first="Edoardo" last="Calderini">Edoardo Calderini</name><affiliation><nlm:aff id="aff2">Pediatric Anesthesia and Intensive Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Locatelli, Marco" sort="Locatelli, Marco" uniqKey="Locatelli M" first="Marco" last="Locatelli">Marco Locatelli</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32333840</idno><idno type="pmc">7176389</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176389</idno><idno type="RBID">PMC:7176389</idno><idno type="doi">10.1016/S0140-6736(20)30927-2</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000496</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000496</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Neurosurgery in an infant with COVID-19</title><author><name sortKey="Carrabba, Giorgio" sort="Carrabba, Giorgio" uniqKey="Carrabba G" first="Giorgio" last="Carrabba">Giorgio Carrabba</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Tariciotti, Leonardo" sort="Tariciotti, Leonardo" uniqKey="Tariciotti L" first="Leonardo" last="Tariciotti">Leonardo Tariciotti</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Guez, Sophie" sort="Guez, Sophie" uniqKey="Guez S" first="Sophie" last="Guez">Sophie Guez</name><affiliation><nlm:aff id="aff3">Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Calderini, Edoardo" sort="Calderini, Edoardo" uniqKey="Calderini E" first="Edoardo" last="Calderini">Edoardo Calderini</name><affiliation><nlm:aff id="aff2">Pediatric Anesthesia and Intensive Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author><author><name sortKey="Locatelli, Marco" sort="Locatelli, Marco" uniqKey="Locatelli M" first="Marco" last="Locatelli">Marco Locatelli</name><affiliation><nlm:aff id="aff1">Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</nlm:aff></affiliation></author></analytic><series><title level="j">Lancet (London, England)</title><idno type="ISSN">0140-6736</idno><idno type="eISSN">1474-547X</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lu, X" uniqKey="Lu X">X Lu</name></author><author><name sortKey="Zhang, L" uniqKey="Zhang L">L Zhang</name></author><author><name sortKey="Du, H" uniqKey="Du H">H Du</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wax, Rs" uniqKey="Wax R">RS Wax</name></author><author><name sortKey="Christian, Md" uniqKey="Christian M">MD Christian</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tien, Hc" uniqKey="Tien H">HC Tien</name></author><author><name sortKey="Chughtai, T" uniqKey="Chughtai T">T Chughtai</name></author><author><name sortKey="Jogeklar, A" uniqKey="Jogeklar A">A Jogeklar</name></author><author><name sortKey="Cooper, Ab" uniqKey="Cooper A">AB Cooper</name></author><author><name sortKey="Brenneman, F" uniqKey="Brenneman F">F Brenneman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Li, G" uniqKey="Li G">G Li</name></author><author><name sortKey="Fan, Y" uniqKey="Fan Y">Y Fan</name></author><author><name sortKey="Lai, Y" uniqKey="Lai Y">Y Lai</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet</journal-id><journal-id journal-id-type="iso-abbrev">Lancet</journal-id><journal-title-group><journal-title>Lancet (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0140-6736</issn><issn pub-type="epub">1474-547X</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32333840</article-id><article-id pub-id-type="pmc">7176389</article-id><article-id pub-id-type="publisher-id">S0140-6736(20)30927-2</article-id><article-id pub-id-type="doi">10.1016/S0140-6736(20)30927-2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Neurosurgery in an infant with COVID-19</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>Carrabba</surname><given-names>Giorgio</given-names></name><email>giorgio.carrabba@policlinico.mi.it</email><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Tariciotti</surname><given-names>Leonardo</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au30"><name><surname>Guez</surname><given-names>Sophie</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au40"><name><surname>Calderini</surname><given-names>Edoardo</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au50"><name><surname>Locatelli</surname><given-names>Marco</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><aff id="aff1"><label>a</label>Neurosurgery Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</aff><aff id="aff2"><label>b</label>Pediatric Anesthesia and Intensive Care Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</aff><aff id="aff3"><label>c</label>Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20143, Italy</aff></contrib-group><pub-date pub-type="pmc-release"><day>22</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>22</day><month>4</month><year>2020</year></pub-date><permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>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.</license-p></license></permissions></article-meta></front><body><p id="para10">Administering general aneasthesia to infants with respiratory infections is a challenge because aneasthetic drugs suppress immunity and can thus contribute to intubation-related mechanical stress and inflammation. Neurosurgery in infants with coronavirus disease 2019 (COVID-19) therefore poses a dilemma because the infection is associated with relative immune suppression and a dysregulated inflammatory response, which act as drivers of the disease.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref></p><p id="para20">From Milan, Italy, we report the case of an 8-month-old male patient with a complex hydrocephalus who had a shunt malfunction during the COVID-19 pandemic. The infant presented with a mild temperature, a dry cough, and an occipital cerebrospinal fluid collection, suggestive for shunt malfunctioning. Neurological examination was negative, but the infant deteriorated and vomited repeatedly. The head CT scan indicated a shunt disconnection. A chest x-ray was negative for overt interstitial pneumonia (<xref rid="sec1" ref-type="sec">appendix</xref>) and the nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2.</p><p id="para30">While the baby showed upper respiratory symptoms due to COVID-19, concerns emerged regarding the need for general anaesthesia for shunt revision. To our knowledge, no reports exist regarding the risk of general anaesthesia in infants with COVID-19. Nevertheless, considering the certainty of progressive neurological deterioration if no intervention was taken, the neurosurgical intervention was arranged.</p><p id="para40">According to the available protocols for patients with COVID-19,<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref> a negative pressure operating room was set up. The staff were provided with full-head hoods, eye protection, filtering facepiece 3 masks, fluid-resistant gowns, double long-sleeved gloves, and impermeable disposable shoe covers. Surgeons and scrubbing nurses had additional sterile surgical suits and an additional pair of long-sleeved gloves.</p><p id="para50">The patient was transferred from a ward dedicated to patients with COVID-19 to the surgical theatre through an isolated and restricted area by trained personnel wearing protective gear.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref></p><p id="para60">Surgery lasted approximately 1 h, and the infant recovered from general anaesthesia promptly. 4 days after surgery, vomiting had worsened and a second neurosurgical revision of the shunt was done. Again, the baby underwent surgery under general anaesthesia without respiratory complications. The baby was promptly extubated, and the neurosurgical course was favourable.</p><p id="para70">To the best of our knowledge, this is the first reported case of an infant with COVID-19 undergoing neurosurgical operations under general anaesthesia. This case might reflect a general observation of relative resistance of babies and children to COVID-19,<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> suggesting the possibility that paucisymptomatic infants with COVID-19 can undergo major surgical procedures without additional morbidity.</p><p id="para80">This early case report needs confirmation and extension and might have broader implications for other surgical procedures addressing potentially life-threatening conditions in infants.</p></body><back><ref-list id="bibl10"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Lu</surname><given-names>X</given-names></name><name><surname>Zhang</surname><given-names>L</given-names></name><name><surname>Du</surname><given-names>H</given-names></name></person-group><article-title>SARS-CoV-2 infection in children</article-title><source>N Engl J Med</source><year>2020</year><comment>published online March 18.</comment><pub-id pub-id-type="doi">10.1056/NEJMc2005073</pub-id></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="sbref20"><person-group person-group-type="author"><name><surname>Wax</surname><given-names>RS</given-names></name><name><surname>Christian</surname><given-names>MD</given-names></name></person-group><article-title>Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients</article-title><source>Can J Anesth</source><year>2020</year><comment>published online February 12.</comment><pub-id pub-id-type="doi">10.1007/s12630-020-01591-x</pub-id></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Tien</surname><given-names>HC</given-names></name><name><surname>Chughtai</surname><given-names>T</given-names></name><name><surname>Jogeklar</surname><given-names>A</given-names></name><name><surname>Cooper</surname><given-names>AB</given-names></name><name><surname>Brenneman</surname><given-names>F</given-names></name></person-group><article-title>Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS)</article-title><source>Can J Surg</source><volume>48</volume><year>2005</year><fpage>71</fpage><lpage>74</lpage><pub-id pub-id-type="pmid">15757044</pub-id></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="journal" id="sbref40"><person-group person-group-type="author"><name><surname>Li</surname><given-names>G</given-names></name><name><surname>Fan</surname><given-names>Y</given-names></name><name><surname>Lai</surname><given-names>Y</given-names></name></person-group><article-title>Coronavirus infections and immune responses</article-title><source>J Med Virol</source><volume>92</volume><year>2020</year><fpage>424</fpage><lpage>432</lpage><pub-id pub-id-type="pmid">31981224</pub-id></element-citation></ref></ref-list><sec id="sec1" sec-type="supplementary-material"><title>Supplementary Material</title><p id="para100"><supplementary-material content-type="local-data" id="ecomp10"><caption><title>Supplementary appendix</title></caption><media xlink:href="mmc1.pdf"></media></supplementary-material></p></sec><ack><p>We declare no competing interests.</p></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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