Rethinking COVID-19 in children: Lessons learned from pediatric viral and inflammatory cardiovascular diseases

Barach, Paul; Lipshultz, Steven E.

doi:10.1016/j.ppedcard.2020.101233

Cited by 9 publications

(3 citation statements)

References 92 publications

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“…The major cytokine inflammation responsible for dramatic fall in systemic vascular resistance, might also lead to additional myocardial ischemia aggravating the process of acute myocardial aggression. This is supported by the requirement of norepinephrine to stabilize compromised hemodynamics in these patients, both in our experience and others' [26,27]. The rise in troponin occurs prior to the elevation of the natriuretic peptide and indicates myocytic damage, which would support significant myocardial injury.…”

Section: Declarations Of Interestsupporting

confidence: 66%

Changes and Outcome of Cardiac Function in Children with SARS-CoV-2 Multisystem Inflammatory Syndrome

Chloé¹,

Thibault²,

de³

et al. 2020

Int J Clin Cardiol

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Background: Cardiac involvement has been reported in children with SARS-CoV-2 inflammatory syndrome. The objectives herein were to assess changes in cardiac parameters and compare cardiac pathologies observed in SARS-CoV-2 to Kawasaki-(KW) and myocarditis-(MY). Methods: Patients < 18 years of age, with symptoms of Kawasaki disease (KW group) and/or of acute myocarditis (MY group) from March 1 to May 31 2020 were included. Clinical, laboratory data, and cardiac parameters were recorded upon diagnosis and at several points over two weeks.Results: Sixteen patients (8 males) diagnosed in the context of SARS-CoV-2 pandemic, were included (8 KW, 8 MY); the mean age was 5.9 years (KW 2.7 years, MY 10.2 years; p = 0.0002). Fever was present in all. Conjunctivitis, buccal inflammation, lymphadenopathies, dermatological lesions were more frequent in KW, chest pain, and gastrointestinal symptoms more frequent in MY. C-reactive protein, procalcitonin, and fibrinogen levels were higher in MY. Platelets were higher, and hemoglobin and hematocrit lower in KW. Troponin and NT pro-BNP were higher in MY. Coronary anomalies were observed in KW, and mitral regurgitation and pericarditis in MY. LV systolic function impairment in MY was concomitant to the highest values of troponin, NT-pro-BNP, CRP, ferritin, D-dimers, and lowest value of lymphocytes and platelets. Mean length of intensive care stay was 7.8 days and that of hospital stay was 9.7 days (MY 5.1 days, KW 14.4 days, p = 0.0008). Systolic function was normalized within 15 days. Diastolic dysfunction appeared after normalization of systolic function. Conclusion:Cardiac injury is parallel to biological changes, as evidenced by serial changes of systolic and diastolic myocardial ultrasound parameters.

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Section: Declarations Of Interestsupporting

confidence: 66%

Changes and Outcome of Cardiac Function in Children with SARS-CoV-2 Multisystem Inflammatory Syndrome

Chloé¹,

Thibault²,

de³

et al. 2020

Int J Clin Cardiol

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“…In previously healthy COVID-19 pediatric patients, Kawasakilike disease and myocarditis have been the main cardiovascular manifestations of SARS-CoV-2. These manifestations are triggered primarily by the massive immune response mounted against the viral infection (50)(51)(52)(53)(54)(55). In fact, elevated levels of inflammatory markers have been noted in patients with COVID-19 associated Kawasaki-like disease or myocarditis (52,54,56).…”

Section: Cardiac Manifestations Of Covid-19 In Pediatric Patientsmentioning

confidence: 99%

COVID-19 in Pediatric Patients: A Focus on CHD Patients

Zareef¹,

Younis²,

Bitar³

et al. 2020

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19) is a global pandemic caused by SARS-CoV-2 virus. As of the 30th of September 2020, around 34,000,000 cases have been reported globally. Pediatrics with underlying congenital heart disease represent a small yet a critical proportion of these patients. In general, the majority of infected children experience mild to moderate disease with significant interindividual variability in laboratory and radiographic findings. Nevertheless, in healthy children with COVID-19, cardiac involvement has been documented and is attributed to various causes. Myocarditis, arrhythmias, cardiogenic shock, and serious multisystem inflammatory syndrome in children are all encountered. Since COVID-19 is a recent novel disease and based on previous experience with respiratory infections, children with underlying congenital heart disease should be given special attention. To date, little data is available about COVID-19 presentation, complications, and appropriate treatment in this population. However, variable and inconsistent disease presentation and severity have been observed. This paper discusses COVID-19 course of illness in pediatric population with a special emphasis on the cardiac manifestations of the disease in healthy population and also on the disease course in congenital heart disease patients in particular.

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“…Multisystemic inflammatory syndrome (MIS-C) with coronary artery aneurysm, fever, mucocutaneous symptoms, and hyperinflammatory symptoms that appear with findings similar to Kawasaki disease during the disease was defined in pediatric patients. These symptoms mostly develop because of immune system activation against viral infection (8)(9)(10). In addition, SARS-CoV-2 can cause serious complications, such as fulminant myocarditis and cardiogenic shock (11).…”

Section: Introductionmentioning

confidence: 99%

Congenital Heart Disease and COVID-19: A Single-Center Experience

Öncül¹,

Karakurt

Elkıran³

et al. 2022

Iran J Pediatr

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Background: Coronavirus disease 2019 (COVID-19) has been infecting children since December 2019 and has caused a severe epidemic and millions of deaths worldwide. COVID-19 has severe clinical effects and is more complicated to manage in patients with underlying diseases, such as congenital heart disease (CHD), past surgical operations, arrhythmia, and end-organ damage. Objectives: This study aimed to evaluate the clinical course, follow-up, and treatment process of patients with CHD and COVID-19 in Inonu University Faculty of Medicine, Department of Pediatrics, Turkey during March 2020-February 2021. Methods: This retrospective study was performed on patients with CHD and COVID-19 in the Department of Pediatrics at Inonu University Faculty of Medicine during March 2020-February 2021, selected by making full count sampling. Admission complaints, clinical findings, biochemical parameters, echocardiography results, hospitalization times, treatments, and clinical follow-up findings were retrieved from patients' files. Results: 11 patients with underlying CHD and COVID-19 were evaluated retrospectively during the study. Ten patients were hospitalized and treated due to COVID-19. Treatment of seven of these patients continued in the intensive care unit (ICU), and five were followed up under a mechanical ventilator. Two patients died during follow-up in the ICU. Conclusions: The clinical course of COVID-19 is severe, and the mortality rate is high in patients with serious diseases, such as underlying CHD. Therefore, COVID-19 in patients with CHD requires more serious and careful follow-up.

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Rethinking COVID-19 in children: Lessons learned from pediatric viral and inflammatory cardiovascular diseases

Cited by 9 publications

References 92 publications

Changes and Outcome of Cardiac Function in Children with SARS-CoV-2 Multisystem Inflammatory Syndrome

Changes and Outcome of Cardiac Function in Children with SARS-CoV-2 Multisystem Inflammatory Syndrome

COVID-19 in Pediatric Patients: A Focus on CHD Patients

Congenital Heart Disease and COVID-19: A Single-Center Experience

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