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[1].
    • 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
Severity of Disease in Children with COVID-19
  • Asymptomatic presentation-
    • No clinical signs or symptoms with normal chest imaging.
    • A large number of children with COVID-19 are asymptomatic.
    • According to the largest study conducted in china of pediatric population(>2000) 4% of children were asymptomatic for COVID-19 infection.
    • According to one study 14.2% of children were asymptomatic[1]. Another study showed 18% of asymptomatic children with COVID-19.
  • Mild Disease
    • Few numbers of children also present with mild manifestations of COVID-19.
    • A study showed 36.3% of children present with a mild form of the disease[1].
  • Severe
    • 2.1% of children present with a severe form of COVID-19 disease[1].
    • Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease.


Complication 1

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 [1] [3]

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[1][3][4]

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 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).
  2. Ruggiero A, Sanguinetti M, Gatto A, Attinà G, Chiaretti A (2020). "Diagnosis of COVID-19 infection in children: less nasopharyngeal swabs, more saliva". Acta Paediatr. doi:10.1111/apa.15397. PMC 7300614 Check |pmc= value (help). PMID 32506693 Check |pmid= value (help).
  3. 3.0 3.1 3.2 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).
  4. Lan L, Xu D, Xia C, Wang S, Yu M, Xu H (2020). "Early CT Findings of Coronavirus Disease 2019 (COVID-19) in Asymptomatic Children: A Single-Center Experience". Korean J Radiol. 21 (7): 919–924. doi:10.3348/kjr.2020.0231. PMC 7289690 Check |pmc= value (help). PMID 32524792 Check |pmid= value (help).