COVID-19 Infection In Children Research Articles

COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies.

Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population. This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy. Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p<.001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR]=2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR=4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR=4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p=.001), but not when unrelated to neutropenia (p=.88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR=1.20, 95% CI: 0.7-2.1). We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.

Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital

Background. The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deathsduring the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives. This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods. This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designatedCOVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results. There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases. Antibiotics were given to 71.7% of patients at the outset.As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at2.2%. Conclusion. Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illnessor comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.

Long-term outcomes of COVID-19 infection in children and young people: a systematic review and meta-analysis

Background Children and young people (CYP) may experience prolonged symptoms following COVID-19, commonly termed ‘Long-COVID’. The characteristics of Long-COVID in CYP are unclear, as are the sequalae of acute COVID-19. We aimed to systematically synthesise evidence of the long-term outcomes of COVID-19 in CYP. Methods 13 electronic databases were searched until January 2022. Inclusion criteria: observational studies reporting outcomes occurring four-weeks or more after COVID-19 in children &lt;18 years old. Exclusion criteria: outcomes of Paediatric Inflammatory Multisystem Syndrome. Title, abstract and full text screening were conducted independently by two reviewers. Data extraction and risk of bias assessment was by one reviewer with independent verification. Critical appraisal tools appropriate for study type were employed. Results were narratively synthesised with meta-analysis to generate summary estimates of risk of prolonged symptoms in CYP. Results 94 studies were included in this systematic review. Of these, 66 studies recruited from hospital settings and 8 studies recruited solely from community settings. Over 100 symptoms were reported, the most common being fatigue, headache and cognitive symptoms. Summary estimates of prevalence of prolonged symptoms were higher for hospital samples (31.2%, 95% CI 20.3% to 43.2%) than for community samples (4.6%, 95% CI 3.4% to 5.8). Reported sequalae of COVID-19 in CYP included stroke, type-1 diabetes, Guillan-Barre syndrome, and persistent radiological or blood test abnormalities. Most studies reporting these sequalae were case reports / case series and the quality of evidence in these studies was low. Conclusions Prolonged symptoms following COVID-19 in children are variable and multi-systemic. Rates of prolonged symptoms in community samples are lower than hospital samples. There is currently limited good quality data on other sequalae in CYP. Heterogeneity in methods of diagnosis of COVID-19, symptom classification, assessment method and duration of follow-up made synthesis less secure.

Association Between SARS-CoV-2 Infection and Cardiovascular Disease in Children and Adolescents: A Cross-sectional Study

Background: The 2019 global coronavirus pandemic is triggered by severe acute respiratory syndrome due to corona virus 2 (SARS-CoV-2). This infection can cause myocardial damage, arrhythmias, acute coronary syndrome, and venous thromboembolism. Objectives: The objective of this study is to provide a comprehensive description of the cardiac manifestations observed in children who have been admitted to the pediatric intensive care unit as a result of SARS-CoV-2 infection. Methods: The current prospective cross-sectional study included patients from Minia University Hospital's pediatric intensive care unit (PICU) isolation unit from April 2022 to April 2023. The study comprised 80 patients divided into two groups: Group I included 46 Corona Virus Induced Disease (COVID-19)-positive patients with cardiac complications. Group II consisted of 34 patients with COVID-19 infection but without cardiac complications. Results: The frequency of cardiac complications was 41.3% (33 children) with arrhythmias and 9% (3 children) with SVT by electrocardiography (ECG), whereas 31.3% of children had myocardial dysfunction (EF &lt; 50%, FS &lt; 25%) on echocardiography (ECHO). In comparison, 7.5% had bundle branch block (BBB). Conversely, 1.3% had pancarditis, and 3.8% had first-degree A-V block. Conclusions: More data is needed on COVID-19's cardiovascular effects on children. We found that acute COVID-19 hospitalized children should have cardiac exams and cardiovascular monitoring. COVID-19 infection in children often impairs systolic function, and arrhythmia may arise in COVID-19 individuals.

Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis

ObjectiveThere are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection.MethodsA systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated.ResultsA total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation.ConclusionsDespite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.

Comparison of Clinic and Demographic Characteristics of Children with Laboratory-Confirmed and Suspected COVID-19 who Admitted to Pediatric Emergency Clinic

Aim: To determine the frequency of COVID-19 infection in children and to compare the parameters of laboratory-confirmed and suspected cases.&#x0D; &#x0D; Material and Methods: Medical records collected with a prospective design of 1300 pediatric patients who applied to COVID-19 triage of pediatric emergency service. Clinic and demographic characteristics of children with laboratory-confirmed and suspected COVID-19 were compared. Nasopharyngeal swab sample was taken from all pediatric patients in accordance with the possible case definition determined by the national Ministry of Health.&#x0D; &#x0D; Results: The COVID-19 test was found positive in 94 (7.2%) children. Of those, 34.5% children had a history of contact, and 31.9% of all cases were asymptomatic. The mean age of children who were positive for COVID-19 was higher than those who were negative (p

Hepatitis –A late manifestation of COVID-19 in pediatric population?

Complete spectrum of covid 19 infection in children as well as its sequaele is still unknown to the world even after two years of ongoing pandemic. Many manifestations of covid 19 have been missed and are yet to be identified. In this study, we aim to hypothesize hepatitis as a probable late manifestation of COVID-19 infection in children. It was a descriptive retrospective study, in which we have included twenty patients who presented with hepatitis in the pediatric department of a secondary level care centre in Sagar from May to July 2021. And we investigated them further to find out the cause of Hepatitis. Among the 20 patients with HEPATITIS, 15 were tested for covid antibody levels, out of them 14 had raised level of SARS-CoV-2 antibody titre. Pediatricians should recognize that the clinical spectrum of COVID-19 in children can be wider than previously described, often with hepatitis as late manifestation of COVID-19 in children, apart from MIS-C.

COVID-19 effects on mental health of children and adolescents with intellectual disabilities in North Kosovo

Background. People with intellectual disabilities (ID) are susceptible to physical, mental and social implications of the COVID-19 pandemic. Aim. Learning the way young individuals with disabilities dealt with the COVID-19 pandemic and how it affected their lives. Materials and Methods. An epidemiological questionnaire including information on the person’s health, mental state, behavior, educational capabilities, and epidemiological and clinical features of the COVID-19 infection was completed by 41 children/young adults and their family members. Results. During the two-year period of the pandemic, we monitored the frequency of COVID-19 infection in children and adolescents with intellectual disorders, children’s mental condition, and the occurrence of post-COVID symptoms. We also discussed the role of society regarding economic stability and support for families with a disabled member. Conclusions. The severity of COVID-19 symptoms was the independent predictor of mental status deterioration. Children and adolescents with ID experienced a greater prevalence of COVID-19 infection as well as post-COVID sequelae.

Obesity is a Risk Factor for Decrease in Lung Function after COVID-19 Infection in Children with Asthma.

Obesity is a Risk Factor for Decrease in Lung Function after COVID-19 Infection in Children with Asthma.

COVID-19 infection in children with cancer in Armenia: report for the whole pandemic period

Background and aims. Immunocompromised pediatric patients with cancer are more susceptible to experiencing severe COVID-19 infection compared to other children. In a global registry study of childhood cancer with COVID-19, involving 1500 patients, severe of critical infections were detected in 20 % of the cases. The mortality rate of 4 % excelled that of the general pediatric population. Data about the development of COVID-19 complications in children with cancer remains limited and varies across different countries. This study aims to describe the incidence and characteristics of COVID-19 infection in children with cancer in Armenia.Methods. A prospective analysis was conducted on PCR-confirmed cases of COVID-19 infection in children with cancer aged 0–18 years from 2020 to 2022 at the Pediatric Cancer and Blood Disorders Center of Armenia, Yeolyan Hematology Center, the only pediatric hematology/ oncology institution in our country.Results. Between June 2020 and March 2022, we studied 201 children with cancer in Armenia, of whom 35 cases of COVID-19 infection were confirmed. The median age was 8.4, and the male/female ratio was 1.3. Among the COVID-19-positive patients, 15 had acute lymphoblastic leukemia, 5 had lymphomas, 4 patients had neuroblastoma, and 2 each had medulloblastoma, rhabdomyosarcoma and Ewing sarcoma. There were single cases of osteosarcoma, acute myeloid leukemia and malignant triton tumor. Twenty patients (57 %) were asymptomatic, and the rest presented with fever, sore throat, and cough. Among the patients with hematological malignancies, four developed pneumonia, and two of them experienced cancer progression subsequently. Additionally, four patients had pancytopenia/thrombocytopenia, likely due to the infection with the Omicron in the last three months of the mentioned period. Overall, the incidence of COVID-19 complications was 11 %, and mortality was zero.Conclusion. This is the first nationwide report on COVID-19 in children with cancer in Armenia. The findings indicate lower rates of severe infection and mortality among compared to global estimates. Further studies are emerging to explore these differences.

2624. The Usual Suspects: A Retrospective Analysis of Pediatric Respiratory Viral Testing During the Pandemic

Abstract Background Contention measures implemented during the pandemic drastically changed the epidemiology of viral respiratory infections. Some reports have shown a sharp decrease in Emergency department visits for respiratory illnesses in the first months of the pandemic with an increase in Respiratory Syncytial Virus (RSV) and Enterovirus (EV) in subsequent months. The concern caused by COVID-19 during the beginning of the pandemic may have led healthcare professionals to underdiagnose other respiratory viral infections. The aim of this study is to evaluate the behavior of viral infection through the pandemic. Methods A retrospective analysis was conducted to determine temporal changes in respiratory panel use and viral epidemiology in the pediatric ED from 2018 to 2022. Medical records were used to determine ICU admission and mortality in those with a positive respiratory panel. Results During the study period, a total of 10,000 respiratory PCR panels were performed in the pediatric ED. There was a significant increase in mean number of panels performed per year during the pandemic period compared to two years prior (2899 vs 198 panels/year). However, the Positivity rate decreased considerably during the pandemic (38.27% vs. 63.54%). Of the 10,000 panels performed, COVID-19 was identified in in 993 cases (9.93%), while other respiratory viruses were identified in 31.27% of cases. The most prevalent virus identified were EV (n=1411, 14.9%) and RSV (n=483, 5.1%). These viruses also had the highest rate of ICU admission and mortality. Patients that tested positive for COVID-19 had a lower rate of ICU admission compared to those infected by other viruses (RR=0.88; CI95%=0.78-0.99). Additionally, the mortality rate associated with COVID-19 was significantly lower than that of other viruses (RR=0.62; CI95%=0.49-0.79). PCR Panel Positivity Rate and Viral Infections in Pediatrics ED from 2018-2022 PCR viral panel tests performed, positive tests, and viral isolates from 2018 to 2022 Conclusion The pandemic increased the use of PCR testing for respiratory illnesses, providing a better picture of seasonal epidemiology of viral infections. Although COVID-19 infection in children was a major of concern, this report shows that throughout the pandemic other viruses were more prevalent and significantly more severe. This study serves as a reminder than even in times of emerging infections, healthcare professionals shouldn’t forget the usual causes of infection. Disclosures All Authors: No reported disclosures

Do sports protect us from COVID-19? An evaluation of COVID-19 infection, vaccination status, and cardiac examination findings in children who exercise.

The COVID-19 pandemic which has devastated the whole world for the past 3 years affects different patient groups differently. This study aims to evaluate the prevalence, symptoms, and severity of COVID-19 infection, vaccination status, and cardiac pathologies of children who exercise. The records of the children and adolescents who applied to our paediatric cardiology outpatient clinic for preparticipation examinations between 01.01.22 and 31.12.2022 were scanned retrospectively, and information about their COVID-19 history, the severity of infection, symptoms during the infection, at the time of the examination, and vaccination status was obtained. The results were analysed using MS Excel 2016 software. The study consisted of 240 children [82 (34.17%) girls and 158 (65.83%) boys] whose mean age was 12.64 ± 2.64 years, mean weight was 50.03 ± 15.53 kg, mean height was 157 ± 15.09 cm, and mean body mass index was 19.65 ± 3.59. 129 cases had a COVID-19 history, 74 cases had no COVID-19 history, and 37 only had contact but no polymerase chain reaction positivity. 84 cases were mild, 19 were moderate, and 12 were asymptomatic. The most common symptoms were fatigue, malaise, headache, sore throat, and fever. 51 cases (35.15%) were vaccinated against COVID-19. No significant cardiac pathologies were detected in electrocardiography or echocardiography. This study shows that COVID-19 infections in children who exercise are generally mild and self-limiting. Our findings suggest that exercise may have positive effects on immunity.

Echocardiography and laboratory outcomes of COVID-19 in children with a history of Kawasaki disease: a preliminary observation.

Infection with SARS-CoV-2 virus has been associated with cardiovascular sequelae including multisystem inflammatory syndrome (MIS-C) in children. Patients with a prior history of Kawasaki disease, may be more susceptible to changes in echocardiographic or laboratory findings after COVID-19. The objective of this study was to investigate the echocardiographic and laboratory findings in children with a prior history of Kawasaki disease after SARS-CoV-2 infection. In this study, we performed a retrospective chart review of 41 children younger than 18 years old who were diagnosed with COVID-19 from April to August of 2022 and had a prior history KD. We included echocardiography and blood draw data obtained at the last outpatient follow-up at our hospital for KD, and within 4 months of SARS-CoV-2 infection. Echocardiographic data obtained from 82 age-matched and gender matched controls were also included for comparison. We found that COVID-19 resulted in slightly higher RCA Z-scores within the first month after infection (mean ± SE, 1.20 ± 0.18 vs. 0.83 ± 0.18, p = 0.030), although this increase did not result in coronary artery dilatation, defined as a Z-score of at least 2.5. In addition, we found that degree of RCA dilatation after COVID-19 infection was negatively correlated with the change in monocyte percentage (Pearson's correlation coefficient-0.363, p = 0.020). Moreover, RCA Z-score changes were lower in patients who received at least one dose of mRNA COVID-19 vaccine when compared those who did not receive any (mean ± SE, -0.23 ± 0.16 vs. 0.39 ± 0.17, p = 0.031). In this pilot study we found that COVID-19 infection resulted in slightly higher RCA Z-scores in children with a prior history of KD, although not large enough to be classified as coronary aneurysms. While these changes could be the result of measurement imprecision or interobserver variation, further study of the cardiac outcomes of COVID-19 infection in children with a prior history of KD are needed in the future.

The clinical features and impact of SARS-CoV-2/COVID-19 infection in children with Cystic Fibrosis (CF): A Qatari experience

The clinical features and impact of SARS-CoV-2/COVID-19 infection in children with Cystic Fibrosis (CF): A Qatari experience

Severe and rare neurological manifestations following COVID-19 infection in children: A Malaysian tertiary centre experience

IntroductionSince the emergence of COVID-19, we have experienced potent variants and sub-variants of the virus with non-specific neurological manifestations. We observed a surge of the Omicron variant of COVID-19 patients with neurological manifestations where less cases of multisystem inflammatory syndrome in children (MIS-C) were reported. This article describes our experience of children with severe and rare neurological manifestations following COVID-19 infection. MethodsThis is a retrospective observational case series of patients under 18 years old who fulfilled the WHO COVID-19 case definition and were referred to our paediatric neurology unit at Hospital Tunku Azizah Kuala Lumpur. Their demographic data, neurological symptoms, laboratory and supporting investigations, neuroimaging, treatment and outcomes were collected and analysed. ResultsThere were eleven patients with neurological manifestations who fulfilled the WHO COVID-19 case definition. Nine patients presented with seizures and/or encephalopathy, one patient with eye opsoclonus and another patient with persistent limbs myokymia. Based on the history, clinical, electrophysiological and radiological findings, two of them had febrile infection-related epilepsy syndrome, two had acute disseminated encephalomyelitis, two had acute necrotising encephalopathy of childhood, one each had hemiconvulsion-hemiplegia-epilepsy syndrome, acute encephalopathy with bilateral striatal necrosis, hemi-acute encephalopathy with biphasic seizures and reduced diffusion, infection-associated opsoclonus and myokymia. ConclusionsThis case series highlighted a wide spectrum of neurological manifestations of COVID-19 infection. Early recognition and prompt investigations are important to provide appropriate interventions. It is essential that these investigations should take place in a timely fashion and COVID-19 quarantine period should not hinder the confirmation of various presenting clinical syndromes.

Computational Analysis of Cardiovascular Effects of COVID-19 Infection in Children

Background: The COVID-19 disease can involve any body part; nevertheless, the most serious consequences affect respiratory and cardiocirculatory systems with variable symptoms. Although the effects of COVID-19 are not fully understood yet, clinical evidence has shown that the virus may cause acute myocardial injury and chronic damages to heart and blood vessels. There is no or limited experience on pathophysiological effects of COVID-19 infection in children’s cardiovascular system. The aim of this work is to assess the effects of COVID-19 on the cardiovascular system in children, in terms, e.g., of increased pulmonary resistances, reduced cardiac contraction capacity. Methods: We used a computational model based on lumped parameters to describe the whole blood circulation. The model was calibrated to account for data coming from pediatric patients. Results: There were total of 17 pediatric patients diagnosed to have COVID-19 infection based on laboratory and clinical findings. The median age was 15 years (range 7 to 17 years), median weight 61 kg (range 25 to 153 kg), median height 165 cm (range 132 to 191 cm) and median body surface area 1.7 (range 0.95 to 2.8). Our results highlighted that the effect of COVID-19 on the cardiovascular system in all children was characterized by the reduction in cardiac blood pressures and volumes. We analyzed in detail two patients showing a correlation between myocardial compromise and severity of the infection. Conclusion: Our study demonstrates that COVID-19 infection causes a complex pathophysiological state to the cardiovascular system, both in asymptomatic and symptomatic pediatric patients. This information is very helpful to prevent long term cardiovascular complications of COVID-19 infection in children. A prospective study with regular cardiology follow-up is recommended.

Retrospective analysis of cases of multisystem inflammatory syndrome associated with COVID-19 infection in children in the Republic of Komi

Multisystem inflammatory syndrome in children (MIS-C) is a new and relatively rare nosology in children associated with COVID-19 infection, which is characterized by severe multiple organ involvement and poses an immediate life threat.Objective: to analyze the clinical, laboratory and instrumental examination data of patients with MIS-C associated with COVID-19 infection, hospitalized in the Republican Infectious Diseases Hospital of the Komi Republic and the Republican Children's Clinical Hospital of the Ministry of Health of the Komi Republic from April 2020 to April 2022.Material and methods. The retrospective study included 15 patients. The diagnosis was verified according to the Guidelines of the Russian Ministry of Health (version dated July 3, 2020). The results of clinical, instrumental and laboratory examination of patients were evaluated in comparison with literature data.Results and discussion. The prevalence of MIS-C in the Komi Republic was 5.5 per 100,000 persons under 18 years of age. The majority of the study cohort were males (66.7%), the median age was 3 years. 46.7% of cases were between the ages of 8 and 14 years. At the onset of clinical manifestations, all patients had fever and gastrointestinal symptoms. In 80% of children, pathological changes of skin and mucous membranes, as well as respiratory disorders were revealed. Involvement of the cardiovascular system in the pathological process was noted in 66.7% of cases. Less frequently, the urinary tract was affected. When analyzing laboratory data, an increase in the level of inflammatory markers, as well as lymphopenia and neutrophilia, were noted. Most patients received therapy with intravenous immunoglobulin and systemic glucocorticoids, as well as anticoagulants and acetylsalicylic acid. The outcomes of the disease in most cases were favorable, in 6.7% of patients a lethal outcome was recorded.Conclusion. The analysis of cases of MIS-C illustrates the high frequency of seroconversion to the SARS-CoV-2 virus, the predominance of males compared to females (2:1 ratio), the prevalence of the age group under 4 years, the heterogeneity of clinical manifestations and generally favorable prognosis. The diversity of clinical features of COVID-19 warrants a high degree of suspicion for MIS-C, as well as the development of a predictive tool, the "MIS-C Suspicion Index".

Multisystem inflammatory syndrome in children: another COVID-19 sequel.

With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.

911-P: Changes in Metrics of Continuous Glucose Monitoring during COVID-19 in Children and Adolescents with Type 1 Diabetes

Background: Data on the changes in glucose control in pediatric patients with type 1 diabetes (T1D) affected by COVID-19 is lacking. We aimed to evaluate changes in metrics of continuous glucose monitoring (CGM) system during COVID-19 infection in children and adolescents with T1D. Methods: We included 21 children and adolescents with T1D, aged younger than 20 years, with at least 70% of CGM readings during COVID-19. Symptoms of COVID-19 infection were investigated through a questionnaire. The effects of COVID-19 on metrics of CGM were assessed at five different time points [2 weeks before-COVID-19 (Time 1), 1 week before-COVID-19 (Time 2), 1 week during COVID-19 (Time 3), 1 week after COVID-19 (Time 4), and 2 weeks after COVID-19 (Time 5)]. Results: Of 21 patients (6 males and 15 females), mean age was 11.4 ± 4.7 years, and mean disease duration was 5.1 ± 4.8 years. All had at least one related symptoms (mean duration of symptoms of 5.2 ± 3.7 days); no one required hospitalization. Glucose management indicator (GMI) and the percentage of time spent above range (&amp;gt; 250 mg/dL) were significantly higher at Time 3 compared to Time 5 (7.8 ± 1.4 % vs 7.2 ± 1.4 %; P = 0.001 and 18.3 ± 18.5 % vs 13.0 ± 15.7 %; P = 0.016, respectively). According to the insulin delivery methods, GMI at Time 2 was significantly higher compared to Time 5 in patients treated with multiple daily injection (MDI) (n = 13) but not in those using continuous subcutaneous insulin infusion (CSII) (n = 6). Conclusion: Pediatric patients with T1D experience mild COVID-19 infection with worsening glycemic control during COVID-19. The use of CSII is more effective in maintaining stable glycemic control during COVID-19 infection compared to MDI therapy. Disclosure H.Kim: None. S.Shin: None. S.Kim: None. J.Kim: None.

The clinical course and outcomes of SARS-CoV-2 virus infection in children: a 24-week follow-up study in Sulaimaniyah, Iraq

Most children infected with the SARS-CoV-2 virus have asymptomatic or mild disease with a short clinical course and excellent outcome; meanwhile, some children experienced persisting symptoms lasting > 12 weeks from the COVID-19 infection diagnosis. This study aimed to define the acute clinical course of SARS-CoV-2 virus infection and outcomes in children after recovery. This prospective cohort study was conducted on 105 children (aged < 16 years) with confirmed COVID-19 infection at Jamal Ahmed Rashid Teaching Hospital, Sulaimaniyah, Iraq, from July to September 2021. The symptomatic and suspicious cases of COVID-19 infection in children were confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. About 85.6% of children fully recovered at ≤ 4 weeks from initial COVID-19 infection diagnosis, 42% were hospitalized, while 15.2% reported long COVID-19 infection symptoms. The most commonly reported symptoms were fatigue (7.1%), hair fall (4.0%), lack of concentration (3.0%), and abdominal pain (2.0%). Children aged 11–16 showed a greater risk of long-term COVID-19 infection symptoms. We also observed a higher risk of long COVID infection symptoms in those who reported ongoing symptoms at 4–6 weeks of follow-up assessment (p = 0.01). Despite mild disease and complete recovery in most children, many suffered from long COVID infection symptoms.