小児におけるCOVID–19の特徴と救急診療上の注意点(Characteristics and considerations in the medical treatment for COVID–19 in children)

要旨 小児における新型コロナウイルス（SARS–CoV–2）による感染症（COVID–19）は，軽症患者が圧倒的に多く，重症化する割合や，死亡の割合は非常に小さい。重症化した小児では，喘息を含む慢性肺疾患，心血管系疾患，免疫抑制状態の患者が多く，基礎疾患をもつ小児では特に注意を要すると考えられている。最近，小児COVID–19の確定または疑い患者において，肺炎像がないにもかかわらず，長引く発熱，腹痛，心機能低下などを伴い，強い炎症反応を呈する症例が報告されているが，SARS–CoV–2感染との関連はまだ不明な点が多い。小児の特徴として不顕性感染が多く，家族内や地域，医療機関において感染源となることが懸念されている。救急医療の現場では不顕性感染の可能性を考慮した感染予防策が必要である。一方，感染予防対策としての外出制限や休校措置は，健康な小児に対し，予想を超える精神的・身体的な影響を及ぼしている可能性がある。身体症状を訴えて受診するなかに精神的なサポートを必要とする小児や，社会的に孤立し救急外来への受診が唯一の社会的接点になっている小児がいる可能性を考慮して，必要に応じソーシャルワーカーなど多職種と連携して対応することが重要である。 ABSTRACT It is rare for children to be in serious condition or die from Coronavirus disease 2019 (COVID–19) due to the 2019 novel coronavirus (SARS–CoV–2) except for those with underlying diseases such as chronic lung disease (including asthma), cardiovascular disease and immunosuppressive disease. Recently, patients with hyperinflammatory shock have been identified among children who are confirmed or in suspicious of SARS–CoV–2 infection. The presenting signs and symptoms are characterized by prolonged fever, abdominal pain and cardiac involvement without any signs of pneumonia on chest CT. However, it is uncertain at this time whether SARS–CoV–2 infection affects this syndrome. Compared to adults, quite a few children are asymptomatic even when infected with SARS–CoV–2, which could make these children serious sources of infection at home or in medical institutions. Considering these characteristics, it is important to take appropriate precautions during medical examinations and perform infection control in emergency departments to save the lives of both children and adult patients. Most healthy children are suffering huge stress due to restrictions against going outside and school closures as social means to control infection. It is possible that children are socially isolated when they come to the emergency department and they might need mental or social supports even if they complain about their physical condition. Healthcare providers are required to examine the children’s circumstances carefully and cooperate with other multi–professional health workers properly.