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]; Abdelrahman Ibrahim Abushouk, MD[3]

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.
  • Illness severity of COVID-19 in children ranges from asymptomatic to critical.

Symptoms

Clinical Course of COVID-19 in children.

  • Asymptomatic presentation-
    • Children present with no clinical signs or symptoms with normal chest imaging.
    • Among 2143 children with COVID-19 infection 4% of children were asymptomatic.[1]
    • According to one study 14.2% of children were asymptomatic. Another study showed 18% of asymptomatic children with COVID-19.
  • Mild Disease
    • Children present with mild symptoms including fever, fatigue, myalgia, cough.[1]
    • Among 2143 children with COVID-19 infection 51% of children had a mild disease of COVID-19.[1]
    • A study showed 36.3% of children present with a mild form of the disease.
  • Severe
    • Children present with dyspnea, central cyanosis, hypoxia.[1]
    • Among 2143 children with COVID-19 infection 5% of children had a severe presentation.[1]
    • 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

Complications

Some of the complications associated with COVID-19 pediatric population are

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

Emergency Warning Signs

Diagnosis

Preliminary WHO case definition: Children and adolescents

  • 0–19 years of age with fever >3 days

AND

  • Two of the following:
  1. Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet)
  2. Hypotension or shock
  3. Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP)
  4. Evidence of coagulopathy (by PT, PTT, elevated D-Dimers)
  5. Acute gastrointestinal problems (diarrhea, vomiting, or abdominal pain)

AND

AND

AND

  • Evidence of COVID-19 (RT-PCR, antigen test or serology-positive), or likely contact with patients with COVID-19

Prevention of MIS-C

  • MIS-C can be prevented by reducing the risk of child exposure to COVID-19 infection.

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. 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]

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. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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 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).