COVID-19 associated pediatric complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Harmeet Kharoud M.D.[2]

Overview


Epidemiology and Demographics


Mode of transmission


Presentations

  • Presentation of COVID-19 is less severe in children as compared to adults.
  • According to CDC, as of April 2, 2020, 1.7% confirmed cases of COVID-19 were reported in children aged <18 years age among the total number of confirmed cases of COVID-19.
  • COVID-19 in children could range from asymptomatic presentation to mild to severe disease.
Symptoms
  • Fever and Cough are one of the most common symptoms reported in children. One study showed fever is prevalent in 47.5% of children and cough in 41.5% among the 1124 children with COVID-19.According to the CDC, fever, and cough was reported in 56% and 54% of children with COVID 19
  • Dyspnea, nasal congestion, pharyngeal erythema, and sore throat are also common presentations in children.
  • Gastrointestinal symptoms-The gastrointestinal manifestation in COVID-19 positive children are diarrhea, vomiting, abdominal pain, nausea, and anorexia. Children can present with gastrointestinal symptoms in the absence of respiratory symptoms.
  • Cutaneous Findings
Clinical Course of COVID-19 in children.
  • Illness severity of COVID-19 in children ranges from asymptomatic to critical as described below.[1]
  • Asymptomatic presentation-
    • No clinical signs or symptoms with normal chest imaging.
    • A large number of children with COVID-19 are asymptomatic.
    • Among 2143 children with COVID-19 infection 4% of children were asymptomatic.
    • According to one study 14.2% of children were asymptomatic[2]. Another study showed 18% of asymptomatic children with COVID-19.
  • Mild Disease
    • Children present with mild symptoms including fever, fatigue, myalgia, cough.
    • Among 2143 children with COVID-19 infection 51% of children had a mild disease of COVID-19.
    • A study showed 36.3% of children present with a mild form of the disease[2].
  • Severe
    • Children present with dyspnea, central cyanosis, hypoxia.
    • Among 2143 children with COVID-19 infection 5% of children had a severe presentation.
    • 2.1% of children present with a severe form of COVID-19 disease[2].
    • Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease.
  • Critical
    • Children present with acute respiratory distress syndrome(ARDS), respiratory failure, shock, or multi-organ dysfunction.
    • Among 2143 children with COVID-19 infection 0.6%% of children had a critical presentation.

Complications

  • Some of the complications associated with COVID-19 pediatric population are
  • Multisystem Inflammatory Syndrome in Children (MISC-C)
  • Exacerbation of the underlying conditions
  • Sepsis
  • Septic shock
  • Secondary Bacterial infections.
Multisystem Inflammatory Syndrome in Children(MIS-C)
  • It is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes.
  • According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past.

Symptoms

  • Fever lasting 24 hours or longer.
  • Vomiting
  • Diarrhea
  • Pain in the stomach
  • Skin rash
  • Red eyes
  • Redness or swelling of the lips and tongue
  • Feeling unusually tired
  • Redness or swelling of the hands or feet

Complication 2

Diagnosis


Most of the children with SARS-CoV-2 infection are either asymptomatic or produce mild symptoms. As asymptomatic patients do not get tested for COVID-19 and are potential carriers for viral transmission, high clinical suspicion is required to prevent such transmissions to a population at risk of developing severe disease. A pediatrician should be cautious to eliminate other causes of respiratory illnesses like seasonal influenza before any diagnostic tests. No diagnostic test is required for a kid with mild illness and no history of exposure to SARS-CoV-2.

Reverse-Transcriptase Polymerase Chain Reaction

U.S. Food and Drug Administration (FDA) has approved real-time Reverse-Transcription Polymerase Chain Reaction (RT-PCR) as the preferred test for diagnosing COVID-19 in children

Lab abnormalities

Studies reportedly showed following lab abnormalities in pediatric patients with COVID-19 [2]

Co-infections

Co-infection with other pathogens were reported in 27% of cases[3]. Some common microorganisms associated with SARS-CoV-2 infection in children are

Radiological findings

CT chest is an important diagnostic modality in pediatric patients with COVID-19. Chest CT scans has reportedly shown higher positive rates in suspected patients than RT-PCR. It has better sensitivity. CT chest and a series of chest X-rays can be used to monitor the progression of the disease. Imaging findings reported in the studies are[2][3]

Children are at increased risk of radiation and its effects, so CT scans and X-rays should be judiciously used in them. It is advised to perform Pulmonary Ultrasonography (USG) in newborns. It has better sensitivity and is safer than CT scans and Chest X-rays.

Treatment


Prevention


References

  1. Eastin, Carly; Eastin, Travis (2020). "Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China". The Journal of Emergency Medicine. 58 (4): 712–713. doi:10.1016/j.jemermed.2020.04.006. ISSN 0736-4679.
  2. 2.0 2.1 2.2 2.3 2.4 de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB (2020). "Clinical manifestations of children with COVID-19: A systematic review". Pediatr Pulmonol. doi:10.1002/ppul.24885. PMID 32492251 Check |pmid= value (help).
  3. 3.0 3.1 Zhang L, Peres TG, Silva MVF, Camargos P (2020). "What we know so far about Coronavirus Disease 2019 in children: A meta-analysis of 551 laboratory-confirmed cases". Pediatr Pulmonol. doi:10.1002/ppul.24869. PMC 7300763 Check |pmc= value (help). PMID 32519809 Check |pmid= value (help).