MIS-C Research Articles

Iron status in children with acute COVID-19 and paediatric inflammatory multisystem syndrome during infection and after recovery

BackgroundCOVID-19 has significant effects on organ function, particularly on lung function and iron metabolism. Studies have shown increased levels of ferritin, an iron storage protein, in COVID-19 patients, indicating potential changes in iron utilization. Research has focused primarily on adults, with limited studies on paediatric patients and a lack of comparisons with MIS-C patients. This study aimed to assess iron status in paediatric COVID-19 patients using traditional and new biomarkers, soluble transferrin receptors (sTfR) and Reticulocyte hemoglobin equivalent (RET-He), to improve diagnosis and prognosis. Additionally, we sought to compare iron status between acute COVID-19 patients and MIS-C patients and evaluate the relationships among iron dysmetabolism, disease severity, and prognosis in paediatric patients. The study also involved monitoring iron status during and after infection to understand its impact on patient severity and prognosis.MethodsA cohort study involving 49 patients aged 1 month to 18 years was conducted at the isolation department of Mansoura University Children's Hospital. The study included 36 patients with acute COVID-19 and 13 with multisystem inflammatory syndrome of childhood (MIS-C). Diagnosis was based on PCR from a deep nasopharyngeal swab or a positive antibody test. Follow-up of survivors was conducted 3 months after recovery. Blood samples were obtained during infection and at follow-up for CBC, Ret-He, iron kinetics, and sTfR analyses.ResultsSignificant iron deficiency anaemia was observed in all patients during infection, with improvement after 3 months of recovery in survivors. The improvement was more obvious in MIS-C patients, with Hb and iron kinetics not significantly affected by disease severity. The STfR was significantly lower in nonsurvivors than in survivors. The ROC curve showed that a baseline sTfR ≤ 18 nmol/L was a statistically significant difference between nonsurvivors and survivors (area under the curve (AUC) = 0.810, p < .001), with 66.7% sensitivity and 82.5% specificity. Regression analysis revealed that patients with baseline sTfRs ≤ 18 nmol/L were 5.9 times more susceptible to death.ConclusionThis study revealed that COVID-19 in children caused iron deficiency anaemia, which improved within 3 months after recovery. Haemoglobin and sTfRs were identified as reliable indicators of IDA in these patients, unlike iron kinetics and RET-He.

Cutaneous Manifestations of Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)

Background: Characteristics of dermatological manifestations are frequently encountered in pediatric COVID-19, similar to the presentation in multisystem inflammatory syndrome in children (MIS-C), which typically emerges following COVID-19 infection. The rash exhibits considerable diversity and lacks specificity. However, investigations into the dermatological features of COVID-19 in children and MIS-C remain limited. Objective: To investigate cutaneous manifestations in both COVID-19 and MIS-C in children. Materials and Methods: Cross-sectional study between February and August 2022 in hospitalized children with COVID-19 who had cutaneous lesions and all hospitalized children with MIS-C. Results: Forty-six cases of COVID-19 patients with dermatological manifestations were identified among 1,602 COVID-19 patients, constituting 2.9%. Additionally, 35 cases of MIS-C were diagnosed. The majority of COVID-19 patients in the present study exhibited mild symptoms, accounting for 42 cases (91.3%). The median age of COVID-19 patients was 1.8 years, which was significantly lower than that of the MIS-C group, which was 4.3 years, with a statistically significant difference (p=0.024). The most common rash types observed in both groups were urticaria, maculopapular rash, and macular erythema. Other rash types noted in COVID-19 included erythema nodosum, Stevens-Johnson syndrome, erythema multiformelike, vesicles, and livedo reticularis. Among MIS-C patients, 31 cases (88.6%) presented with mucocutaneous manifestations, with 26 cases (74.3%) exhibiting concurrent mucocutaneous involvement. There was no significant difference in the occurrence of cardiac symptoms between the group with mucocutaneous manifestations and/or dermatological symptoms, which was 81.8%, compared to the group without mucocutaneous or dermatological symptoms, which was 100% (p=0.102). Conclusion: The cutaneous manifestations in pediatric COVID-19 and those with MIS-C vary widely and are non-specific. In patients presenting with fever and rash during a COVID-19 outbreak, recognizing these cutaneous symptoms is crucial for prompt diagnosis and treatment especially those who are asymptomatic. Further studies involving COVID-19 patients, both with and without rash, may provide correlation between disease progression and skin manifestation.

Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City

Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19-PIMS-grade 3: A Case Report

Background: In the face of the rise of COVID-19, the multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 has been reported, and an increase in MIS-C cases has been observed throughout the world. The majority of these cases were similar to Kawasaki disease concerning clinical presentation. Case Presentation: Despite similarities, MIS-C cases present clinical and laboratory differentiation, which makes it essential to portray similar cases worldwide to have a better consensus in the future. A 7-year-old male child visited the hospital with the chief complaints of fever associated with chills, rigors, and excessive myalgia for 3 days. He had a history of elevated high C-reactive protein (CRP) of 42.7 mg/L. He was diagnosed with Paediatric inflammatory multisystem syndrome (PIMS)-grade 3. Here, for the first time, we bring an Indian MIS-C case with COVID-19-associated Paediatric inflammatory multisystem syndrome (PIMS)-grade 3. Conclusion: PIMS-TS infection in paediatrics is associated with a wider range of complications, and the importance of musculoskeletal complications in PIMS-TS has been discussed.

Trends in Pediatric Hospital Admissions Caused or Contributed by SARS-CoV-2 Infection in England

To investigate the changing characteristics of SARS-CoV-2 related pediatric hospital admissions over time. A national, observational cohort study from 1, July 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45,203 children under 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with "incidental" infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or PIMS-TS. There were 45,920 SARS-CoV-2 related hospitalizations in children: 34,870 (75.9%) due to COVID-19; 1,845 (4.0%) due to pediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS); 8,330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first three waves (March 2020 through November 2021) and the omicron era (December 2021 onwards) were: a fall in PIMS-TS from 1,575 of 14,020 (11.2%) to 270 of 31,905 (0.8%); a reduction in critical care use from 1,175 of 14,020 (8.4%) to 1,390 of 31,905 (4.4%); a fall in mortality rate among those hospitalized from 521 per 100,000 to 249 per 100,000; and a drop in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4,225 of 14,020 (30.1%) admissions 2020 through 2021 and 15,555 of 31,900 (48.8%) since 2022. (p<0.001 for all comparisons). Infants are now the most affected age group by SARS-CoV2, at least partially related to having the least immunity to the virus, and are most vulnerable to respiratory illnesses.

Pediatric Multisystem Inflammatory Syndrome in a Patient with a Coma with a Hyperosmolar Component in the Manifestation of Type 1 Diabetes Mellitus: Clinical Case

Background. Due to the rarity of the combination of emergence diabetes mellitus type 1 (DM1), COVID-19, and multisystem inflammatory syndrome, each reported case represents valuable experience and increases the awareness of medical professionals. Clinical case description. A 7-year-old boy was admitted to the intensive care unit with a diagnosis of diabetes mellitus type 1, first identified. On day 2, ketoacidotic coma with a hyperosmolar component developed, a positive polymerase chain reaction (PCR) test for SARS-CoV-2 was obtained, and a picture of subarachnoid hemorrhage was described according to CT scans of the brain. On day 3, macrohematuria, peripheral edema, pasty complexion were noted; the clinical picture and laboratory examination data corresponded to a “cytokine storm” with the development of multiple organ failure. On day 5, tonic-clonic seizures and bloody discharge from the nasopharynx were noted. On day 6, a negative PCR test for SARS-CoV-2 was obtained, on chest X-rays there was a heterogeneous decrease in pneumatization in the basal sections on both sides, and bilateral hydrothorax. On day 9, meningeal symptoms were noted. On day 14, a repeated episode of a convulsive attack was registered, and changes in the brain according to MRI results were regarded as an inflammatory demyelinating lesion against the background of the course of multisystem inflammatory syndrome and DM or as posterior reversible encephalopathy (PRES syndrome). Against the background of the appointment of immunomodulatory, anticoagulant, antibacterial, antiviral therapy, positive dynamics was noted in the child's condition. On day 18, the patient in a stable condition of moderate severity was transferred to the Department of Pediatric Endocrinology for further treatment. After 14 days, the child was discharged from the hospital in a satisfactory condition. Conclusion. This case report may confirm the risk of developing multisystem inflammatory syndrome in children with DM1 and COVID-19, which requires an interdisciplinary approach and the appointment of therapy included in the standards of management of children with multisystem inflammatory syndrome.

COVID-19 in Brazilian Pediatric Patients: A Retrospective Cross-Sectional Study with a Predictive Model for Hospitalization.

This study was conducted to ascertain the most frequent symptoms of COVID-19 infection at first consultation in a pediatric cohort and to devise a predictive model for hospitalization. This is a retrospective cross-sectional study of 1028 Brazilian patients aged <18 years with SARS-CoV-2 infection in a single reference hospital in the first year of the pandemic. Clinical, demographic, laboratory, and disease spectrum data were analyzed via multivariate logistic regression modeling to develop a predictive model of factors linked to hospitalization. The majority of our cohort were schoolchildren and adolescents, with a homogeneous distribution concerning sex. At first consultation, most patients presented with fever (64.1%) and respiratory symptoms (63.3%). We had 204 admitted patients, including 11 with Pediatric Multisystem Inflammatory Syndrome. Increased D-dimer levels were associated with comorbidities (p = 0.018). A high viral load was observed in patients within the first two days of symptoms (p < 0.0001). Our predictive model included respiratory distress, number and type of specific comorbidities, tachycardia, seizures, and vomiting as factors for hospitalization. Most patients presented with mild conditions with outpatient treatment. However, understanding predictors for hospitalization can contribute to medical decisions at the first patient visit.

PIMS-TS Complicating SARS-CoV-2 Infection: A Report of 10 Pediatric Cases

SARS-CoV-2, or COVID-19, is a betacoronavirus identified by the WHO as the cause of the 2020 pandemic. Unlike most respiratory virus, children exhibit lower susceptibility to COVID-19 and generally develop milder disease courses, with reduced mortality rates. Recently, there have been reports of clustered cases characterized by shock states associated with elevated cardiac biomarkers and vasoplegia, necessitating treatment with inotropes, vasopressors, and fluid resuscitation. This clinical presentation has been linked to the emergence of Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), also known as Kawasaki-like syndrome. This study is a retrospective analysis of 10 pediatric patients diagnosed with PIMS-TS secondary to COVID-19 infection, who were admitted to Mohammed VI International University Hospital in Casablanca, Morocco, from January 2021 to October 2023. The cohort&amp;apos;s ages ranged from 2 to 13 years, with a mean age of 6 years, and demonstrated a male predominance (sex ratio 9M:1F). Clinical manifestations included prolonged fever, gastrointestinal disturbances, rash, conjunctivitis, and cheilitis. Laboratory findings revealed elevated levels of CRP, PCT, and ferritin, indicative of an atypical Kawasaki syndrome. These patients responded to intravenous immunoglobulin therapy, with adjunctive corticosteroids administered as needed. All patients experienced favorable outcomes, with resolution of systemic involvement and normalization of inflammatory markers, and no relapses or fatalities were recorded. The risk factors for PIMS-TS complicating COVID-19 infection remain unclear. However, there are noted parallels between PIMS-TS and Kawasaki syndrome diagnostic criteria, suggesting possible pathophysiological overlap. In conclusion, a novel multisystem inflammatory syndrome associated with COVID-19 infection, resembling Kawasaki syndrome, has been identified in pediatric patients. This emerging syndrome enhances our understanding of the complex pathophysiology associated with COVID-19 and underscores the need for continued research into its etiology and optimal management strategies.

Prediction and Course of Diastolic Dysfunction in COVID-19 Associated Pediatric Multisystem Inflammatory Syndrome

Background: To predict the risk for diastolic dysfunction on admission and assess repetitive cardiac function during the follow-up of individuals diagnosed with multisystem inflammatory syndrome associated with COVID-19 (MIS-C). Methods: This prospective, single-center study comprises patients who were divided into two groups: Mitral E/e'≥8 and mitral E/e' &lt; 8 on the first admission. During follow-up, patients underwent repeated echocardiography (on the first admission and at 1 week, 1 month, and 3 months post-procedure) between December 2020 and June 2022. Results: Among the 92 patients included in this study, 32 are females. Procalcitonin, erythrocyte sedimentation rate, B-type natriuretic peptide (proBNP), ferritin, and interleukin-6 (IL-6) values were found to be significantly higher in the E/e' ≥ 8 groups than that in the mitral valve E/e' 70.3, proBNP of &gt; 278.5, and procalcitonin of &gt; 2.4 was identified as an effective cut-off point in the mitral E/e’(&gt; 8) for patients with MIS-C area under the curve (AUC) = 0.743, 95% confidence interval (CI) = 0.599 - 0.887, P = 0.005, sensitivity: 72%, specificity: 74% for IL-6; AUC = 0.680, 95% CI = 0.535 - 0.825, P = 0.037, sensitivity: 72%, specificity: 60% for proBNP; and AUC = 0.672, 95% CI = 0.528 - 0.816, P = 0.046, sensitivity: 72%, specificity: 60% for procalcitonin). Conclusions: Tissue Doppler imaging findings of diastolic dysfunction seem to be improved until the third month. Tissue Doppler imaging findings of diastolic dysfunction appear to ameliorate until the third month. Mitral valve E/e’&gt; 8 value is significantly associated with IL-6, proBNP, and procalcitonin values in patients with MIS-C. IL-6, proBNP, and procalcitonin values were determined as independent high-risk indicators for left ventricular diastolic dysfunction.

In Reply: High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

In Reply: High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

Human Genetic and Immunological Determinants of SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces pneumonia and acute respiratory failure in Coronavirus Disease 2019 (COVID-19) patients with inborn errors of immunity to type I interferon (IFN-I). The impact of SARS-CoV-2 infection varies widely, ranging from mild respiratory symptoms to life-threatening illness and organ failure, with a higher incidence in men than in women. Approximately 3 to 5% of critical COVID-19 patients under 60 and a smaller percentage of elderly patients exhibit genetic defects in IFN-I production, including X-chromosome-linked TLR7 and autosomal TLR3 deficiencies. Around 15 to 20% of cases over 70 years old, and a smaller percentage of younger patients, present with preexisting autoantibodies neutralizing type I interferons. Additionally, innate errors affecting the control of the response to type I interferon have been associated with pediatric multisystem inflammatory syndrome (MIS-C). Several studies have described rare errors of immunity, such as XIAP deficiency, CYBB, SOCS1, OAS1/2, and RNASEL, as underlying factors in MIS-C susceptibility. However, further investigations in expanded patient cohorts are needed to validate these findings and pave the way for new genetic approaches to MIS-C. This review aims to present recent evidence from the scientific literature on genetic and immunological abnormalities predisposing individuals to critical SARS-CoV-2 infection through IFN-I. We will also discuss multisystem inflammatory syndrome in children (MIS-C). Understanding the immunological mechanisms and pathogenesis of severe COVID-19 may inform personalized patient care and population protection strategies against future serious viral infections.

Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City

The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 μL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

Paediatric Post-Traumatic Stress Risk for Young People and Parents following Acute Admission for Paediatric Multisystem Inflammatory Syndrome: Retrospective Analysis of Psychological Screening and Support.

Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) is a novel condition that was identified for the first time during the COVID-19 pandemic. Limited research exists that describes the psychological needs of children and young people (CYP) following an acute hospital admission for PIMS-TS. A retrospective cohort study was conducted to explore both psychological need and access to psychology services for CYP and their families who were admitted to a paediatric tertiary hospital in London, UK, for PIMS-TS between April 2020 and May 2021. We included 121 CYP and a parent/caregiver for each. In total, 23.3% of the CYP were at risk of developing a traumatic stress response and 11.6% were at risk of experiencing emotional disturbance. Of the parents screened, 40.5% also scored above clinical cut-off for a trauma response. There was a significant relationship observed between CYP and parents identified as having a trauma risk. The importance of proactive screening for both trauma and emotional distress in CYP and their parents/caregivers following acute hospital admission is highlighted. In addition, there is a need to think about a CYP as part of a system of care and to ensure that clinicians pay attention to parental wellbeing and mental health when understanding the psychological impact on a child.

Cardiac Follow up of Pediatric Patients Presented with Covid-19 Cardiovascular Affection

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 carditis, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. Aim of the Work To Follow up of Pediatric Patients Presented with Covid-19 Cardiovascular Affection. Patients and Methods This was an analytical Prospective Cohort study conducted on 33 patients with post COVID-19 infection. all patients were subjected to the following:(demographic data, clinical signs &amp; symptoms, laboratory investigations and Echocardiogrsphy at presentation, 1,6 weeks and 3months follow up from January 2021 to August 2021 to evaluate the short and mid- term effect of COVID-19 infection on cardiac function, and outcomes for pediatric multisystem inflammatory syndrome related to covid-19. Results In our study all patients fulfilled criteria of MIS-C presented with Kawasaki disease(KD)- like symptoms and gastrointestinal symptoms in addition to fever with shock or cardiac dysfunction. Our patients were presented with the following vital data: tacycardia with mean of 132.82 (18.74) beat/minute, hypotension with mean of 88.03 (14.06) (mmhg) for systolic blood pressure &amp; mean of 49.39 (14.78) mmhg for diastolic blood pressure, spo2 mean 96.27 (2) %, high grade fever of mean 38.36(0.79). KD-like features were seen in many patients (skin rash in 66.7%, conjunctivitis in 75.8% and Cardiovascular abnormalities were seen in 100% e.g. (myocardial dysfunction, valvular regurgitation, pericardial effusion and shock. Our MIS-C patients had signs and symptoms of an inflammatory state e.g.(fever, rash, conjunctivitis and diarrhea(gastroenteritis). Conclusion MIS-C is a hyper-infammatory syndrome affecting multiple organs especially the heart and is triggered by SARS-CoV-2 infection. It is usually seen 2–4 weeks following infection. In our study,IVIG and steroids might have a beneficial role in MIS-C management.

Pediatric inflammatory multisystem syndrome or Kawasaki disease - continuous challenges in Pediatrics - case report

Introduction. Kawasaki disease (KD) and pediatric inflammatory multisystem syndrome (PIMS) are similar vasculitis conditions affecting medium and small vessels, particularly the coronary arteries. This study aimed to highlight diagnostic and treatment challenges in a case initially diagnosed as PIMS, which evolved into atypical KD. Materials and methods. A 2-year-10-month-old male was admitted with a high fever persisting for 6 days, unresponsive to antipyretics. Results. On admission, the patient exhibited a poor general condition, pale skin, non-pruritic erythematous rash, and enlarged, non-painful lymph nodes. Laboratory tests showed elevated inflammatory markers, leukocytosis with neutrophilia, hypoalbuminemia, liver enzyme abnormalities, altered cardiac markers, and elevated D-dimers, but no initial echocardiographic changes. Positive SARS-CoV-2 antibodies led to an initial PIMS diagnosis, and treatment with intravenous methylprednisolone, antiplatelet, anticoagulant therapy, and hepatoprotective agents was started. The patient’s condition initially improved but then worsened with febrile spikes, rash, neutropenia, thrombocytopenia, anemia, and coronary artery dilation on echocardiography. This led to a diagnosis of KD with atypical onset, and treatment with immunoglobulin, antiplatelet, and anticoagulant therapy was initiated. The patient’s condition improved slowly. Conclusions. KD and PIMS share overlapping characteristics, making them difficult to distinguish. There is no definitive criterion to differentiate KD and PIMS, leading to potential diagnostic errors.

Programmed Cell Death Protein-1 Regulation in Response to SARS-CoV-2 in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2: A Prospective Cohort Study.

The role of programmed death cell protein 1 (PD-1) has already been described in a range of various diseases, including COVID-19. This study provides new, innovative data, related to the expression of PD-1 and the risk of Paediatric Inflammatory Multisystem Syndrome, temporally associated with SARS-CoV-2 infection (PIMS-TS)-a rare, but potentially life-threatening complication of COVID-19. In this study, we evaluated the expression of PD-1 protein in patients with PIMS. Blood samples were taken from patients at the time of diagnosis (n = 33), after 6 weeks (n = 33), 3 months (n = 24), 6 months (n = 24) and 12 months (n = 8). The immunophenotypes were evaluated in flow cytometry. The control group consisted of 35 healthy children with negative SARS-CoV-2 antigen/PCR test, who were asymptomatic and had no history of allergic, autoimmune or oncological diseases. The associations between immunophenotypes, biochemical findings and clinical data were analysed. Significant increases in the expression of PD-1 for CD4+ and CD8+ T cells, compared to the control group, were observed in the day of admission, with a gradual decrease during the first weeks from initiation of treatment. This study sheds new light on the pathogenesis of PIMS-TS, emphasizing the role of PD-1 protein. Future research is essential for early risk prediction in SARS-CoV-2 patients and for devising effective clinical prevention and management strategies.

Covid-19 in pediatrics: A systematic review of the most frequent signs and symptons in the pediatric population

Introduction: Coronavirus or Covid-19 is an infectious disease produced by SARS-CoV-2 that in 2019 generated a wave of infections throughout the world, where in March 2020 the World Health Organization (WHO) declared that the situation was no longer considered an epidemic but rather a pandemic, such a disease affected both adult and pediatric patients, but the disease in children has a much more benign behavior than that seen in adults, thus the number of articles published having focus on this group is much greater than that on children. Material and Methods: A systematic review of the literature available in different databases was carried out, focusing on PUBMED. Selecting those articles that were best related to the proposed topic. Results: The results obtained show that more non-specific symptoms such as fever, cough, diarrhea, sore throat are the most frequent and that when the patient presents atypical symptoms such as anosmia or ageusia, which are more frequent in adults, the probability of a positive diagnosis is greater. Even if the pathology is more benign, there is also the probability that these same patients present some complication, such as pediatric Multisystem Inflammatory Syndrome (SIM-p), which has a wide spectrum of manifestations and which, if not diagnosed and treated, leads the patient to death. Conclusion: According to published studies, the symptoms presented are very non-specific and not very serious, so it is not a pathology that frequently carries a risk to health, even though some cases have an evolution that can develop complications and very rarely to death

Swissped-RECOVERY: masked independent adjudication for the interpretation of non-randomised treatment in a two-arm open-label randomised controlled trial (methylprednisolone vs immunoglobulins) in Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) involving 10 secondary and tertiary paediatric hospitals in Switzerland

ObjectivesIn trials of acute severe infections or inflammations frequent administration of non-randomised treatment (ie, intercurrent event) in response to clinical events is expected. These events may affect the interpretation of...

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.

Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. This national multicenter comparative study comprised all patients under 18years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.