Introduction: The data on long COVID in children is scarce since children and adolescents are typically less severely affected by acute COVID-19. This study aimed to identify the long-term consequences of SARS-CoV-2 infection in children, and to compare the persistent symptom spectrum between COVID-19 and community-acquired infections of other etiologies.Methods: This was an ambidirectional cohort study conducted at the Children's Clinical University Hospital in Latvia. The study population of pediatric COVID-19 patients and children with other non-SARS-CoV-2-community-acquired infections were invited to participate between July 1, 2020, and April 30, 2021.Results: In total, 236 pediatric COVID-19 patients were enrolled in the study. Additionally, 142 comparison group patients were also enrolled. Median follow-up time from acute symptom onset was 73.5 days (IQR; 43–110 days) in the COVID-19 patient group and 69 days (IQR, 58–84 days) in the comparison group. Most pediatric COVID-19 survivors (70%, N = 152) reported at least one persistent symptom, but more than half of the patients (53%, N = 117) noted two or more long-lasting symptoms. The most commonly reported complaints among COVID-19 patients included persistent fatigue (25.2%), cognitive sequelae, such as irritability (24.3%), and mood changes (23.3%), as well as headaches (16.9%), rhinorrhea (16.1%), coughing (14.4%), and anosmia/dysgeusia (12.3%). In addition, 105 (44.5%) COVID patients had persistent symptoms after the 12-week cut-off point, with irritability (27.6%, N = 29), mood changes (26.7%, N = 28), and fatigue (19.2%, N = 20) being the most commonly reported ones. Differences in symptom spectrum among the various age groups were seen. Logistic regression analysis showed that long-term persistent symptoms as fever, fatigue, rhinorrhea, loss of taste and/or smell, headaches, cognitive sequelae, and nocturnal sweating were significantly associated with the COVID-19 experience when compared with the controls.Conclusions: We found that at the time of interview almost three-quarters of children reported at least one persistent symptom, but the majority of patients (53%) had two or more concurrent symptoms. The comparison group's inclusion in the study allowed us to identify that symptom persistence is more apparent with COVID-19 than any other non-SARS-CoV-2 infection. More research is needed to distinguish the symptoms of long COVID from pandemic-associated complaints. Each persistent symptom is important in terms of child well-being during COVID-19 recovery.

The total number of COVID-19 positive cases in Latvia has escalated rapidly since October 2020, peaking in late December 2020 and early January 2021. Children generally develop COVID-19 more mildly than adults; however, it can be complicated by multisystem inflammatory syndrome in children (MIS-C). This case study aims were to assess demographic characteristics and the underlying medical conditions, and clinical, investigative and treatment data among 13 MIS-C patients using electronic medical records. All 13 had acute illness or contact with someone who was COVID-19 positive two to six weeks before MIS-C onset. Only five of the 13 were symptomatic during the acute COVID-19 phase. The median age was 8.8 years; 11/13 patients were male, 10/13 had been previously healthy, and all 13 patients tested positive for SARS-CoV-2 by RT-PCR or antibody testing. The most commonly involved organ systems were the gastrointestinal (13/13), hematologic (13/13), cardiovascular (13/13), skin and mucosa (13/13), and respiratory (12/13) ones. The median hospital stay was 13 (interquartile range, 11 to 18) days; 7/13 patients received intensive care, 6/13 oxygen support, and 5/13 received inotropic support. No deaths occurred. During the current pandemic, every child with a fever should have a clearly defined epidemiological history of COVID-19, a careful clinical assessment of possible multiple organ-system involvement, with a special focus on children with severe abdominal pain and/or skin and mucocutaneous lesions.

Introduction. Congenital diaphragmatic hernia (CDH) - a relatively rare developmental defect due to a failure of pleuroperitoneal canal closure. The size of the defect between abdominal and thoracic cavities may be variable and it may have a significant impact on the clinical manifestation and prognosis. In this study we set out additional factors to determine if they affect the outcome of the newborns with CDH. Aim of the Study. To investigate and analyze the influence of selected postnatal prognostic factors for predicting the outcome. The primary outcome measure was survival. Material and methods. The present study is retrospective including the data collection and analysis of medical documentation of patients born with CDH and treated in the Children’s Clinical University hospital between 2012 and 2017. The selected prognostic factors included antenatal diagnostics, Apgar score at 1' and 5', need for an early intubation (≤ 3 h after birth), initial blood gases in first 24 h of life, time interval between delivery and surgical therapy, the stomach and liver presence in the thorax, additional congenital abnormalities, a type and duration of invasive ventilatory support. Outcome parameters were compared between survivors (S) and non-survivors (NS). Results. 19 patients (pts) were identified - 14 S and 5 NS. Total mortality rate - 26%. 17/19 had left-sided, 2/19 - right-sided CDH. 17/19 pregnancies were monitored, prenatal diagnosis was made in 8 pts - 3 of them NS. The mean Apgar score at 1’ in S group was 5,5, NS - 5,0. At 5’ - 6,7 and 5,6. Need for an early intubation was 64% for S, 100% - NS. Initial blood gases in S (n=11) and NS (n=5) showed the mean pH value of 7,18 and 7,02. Mean PaCO2 - 62,92 and 77,42 mm Hg. 16/19 underwent the operation. 2 pts died before and 3 after surgical therapy. The average time interval between delivery and surgical therapy in S group was 31,6 hours, NS - 73,7 h. The intrathoracic liver was observed in 3 pts, 2 of them died, the intrathoracic stomach - 2, none of them died. 14/16 pts had a primary surgical repair (PR), 2/16 - Silo closure before total repair. 6 pts had additional congenital defects - 2/14 S and 4/5 NS. 5 out of all 6 had cardiac anomalies. The average required conventional ventilation time in S (n=9) was 175,9 h, NS (n=3) - 25,7 h. High-frequency oscillatory ventilation for S (n=6) was applied for 255 h, NS (n=5) 157,3 h. The results showed statistically significant relationship between the outcome and additional abnormalities (r(17)=.623, p=0.017) and time interval between delivery and surgical therapy (r(11)=.768, p=.014). Conclusions. The possible predictors of outcome were additional abnormalities and time interval between delivery and surgical therapy.

Background Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are usually asymptomatic or have mild coronavirus disease (COVID) with low rates of hospitalization. Two long-term consequences have been described after SARS-CoV-2 infection. The first is multisystem inflammatory syndrome in children (MIS-C) and the second is “long COVID”. Data on long COVID in pediatric patients has increasingly been published, giving new insights into the ways this phenomenon affects children. This study aimed to describe the persistent symptom spectrum of patients with acute SARS-CoV-2 infection and MIS-C two months after the diagnosis. Method This was a prospective cohort study conducted at the Children's Clinical University Hospital in Latvia. The study population of pediatric COVID-19 and MIS-C patients were invited to participate between December 1, 2020, and December 31, 2021. The study included children with moderate and severe acute SARS-CoV-2 infection who required hospitalization and MIS-C. Overall, 53 acute Covid-19 and 22 MIS-C patients were enrolled in the study. All patients were evaluated by specially designed assessment protocols. The Ethics Committee of Riga Stradins University reviewed and approved the study protocol questionnaire and informed consent forms (approval No. 6-1/07/35). Descriptive statistics were used to present the data. Results Data showed that two months after acute SARS-CoV-2 infection 84% (n=45) of patients had at least one persistent symptom. In addition, 73% (n=16) of MIS-C patients reported at least one persistent symptom. Generally, the most commonly reported complaints among COVID-19 patients included rhinorrhea (41%), cognitive sequelae such as mood swings (38%) and irritability (36%), prolonged cough (30%), anxiety (19%), night sweats (15%), sore throat and shortness of breath (13%). In the MIS-C patient group - body weight changes and mood swings (36%), irritability (27%), poor attention (23%), fatigue (18%), and in 14% of cases were observed myalgia, night sweats, difficulties concentrating and anxiety. There were other similar but less common complaints in both groups, such as prolonged fever, nausea, shortness of breath, dizziness and memory impairment. Conclusion We found that at the time of interview more than half of COVID-19 and MIS-C patients reported at least one persistent symptom. Symptoms including rhinorrhea, mood swings, irritability, prolonged cough, poor attention and fatigue were the most frequently reported complaints of long COVID-19 after acute SARS-CoV-2 infection and MIS-C, representing the wide range of symptoms affecting children.