COVID-19 Infection in Children: Diagnosis and Management

Abstract

Purpose of Review Due to the rapidly changing landscape of COVID-19, the purpose of this review is to provide a concise and updated summary of pediatric COVID-19 diagnosis and management. Recent Findings The relative proportion of pediatric cases have significantly increased following the emergence of the Omicron variant (from < 2% in the early pandemic to 25% from 1/27 to 2/3/22). While children present with milder symptoms than adults, severe disease can still occur, particularly in children with comorbidities. There is a relative paucity of pediatric data in the management of COVID-19 and the majority of recommendations remain based on adult data. Summary Fever and cough remain the most common clinical presentations, although atypical presentations such as “COVID toes,” anosmia, and croup may be present. Children are at risk for post-infectious complications such as MIS-C and long COVID. Nucleic acid amplification tests through respiratory PCR remain the mainstay of diagnosis. The mainstay of management remains supportive care and prevention through vaccination is highly recommended. In patients at increased risk of progression, interventions such as monoclonal antibody therapy, PO Paxlovid, or IV remdesivir × 3 days should be considered. In patients with severe disease, the use of remdesivir, dexamethasone, and immunomodulatory agents (tocilizumab, baricitinib) is recommended. Children can be at risk for thrombosis from COVID-19 and anticoagulation is recommended in children with markedly elevated D-dimer levels or superimposed clinical risk factors for hospital associated venous thromboembolism.

Possible COVID-19 Maternal-to-Neonate Vertical Transmission in a Case of Early Neonatal Infection

“…Managing COVID-19-infected newborns < 28 days can be challenging, as no approved antiviral medications are available. Antiretrovirals such as remdesivir have emergency use authorization (EUA) for infants > 28 days and > 3.5 kg [ 20 ], while Paxlovid and monoclonal antibodies have EUA for children 12 years and older [ 21 ]. A double-blind study comparing ivermectin vs. placebo showed decreased viral load in COVID-19 adult patients, but the use of the same has not been evaluated adequately with the associated side effects [ 22 - 23 ].…”

COVID-19 Co-Infection May Promote Development of Sinusitis Complication in Children

“…Up to 65% of young patients may be asymptomatic, and among the general symptoms, fever and cough are the most common. Less frequently, in atypical cases, anosmia and croup may be observed [ 13 ]. Notwithstanding, the available literature shows the multiplicity of SARS-CoV-2 infection complications in this population.…”

The Absence of Permanent Sensorineural Hearing Loss in a Cohort of Children with SARS-CoV-2 Infection and the Importance of Performing the Audiological “Work-Up”

“…According to the published criteria [ 21 ], based on clinical, laboratory and radiological profiling, symptomatic SARS-CoV-2 infections can be graded as mild, moderate, severe, or critical. Among COVID-19-related major complications, MIS-C [ 29 ] and Vasculitis [ 30 ] were described according to the literature. MIS-C is a life-threatening situation characterized by fever for at least 24 h, laboratory evidence of inflammation, evidence of clinically significant illness requiring hospitalization with multisystem involvement, evidence of prior or current SARS-CoV-2 infection, and no alternative plausible diagnosis [ 29 ].…”