The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID‐19: A 6‐months prospective study

Abstract

Objectives: To perform a comprehensive clinic, laboratory, and instrumental evaluation of children affected by coronavirus disease .Methods: Children with a positive result of nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underwent laboratory tests, anal and conjunctival swab, electrocardiography, lung, abdomen, and cardiac ultrasound.Twenty-four-hour ambulatory blood pressure monitoring was performed if abnormal basal blood pressure. Patients were followed-up for 6 months.Results: Three hundred and sixteen children were evaluated; 15 were finally included. Confirmed family member SARS-CoV-2 infection was present in all.Twenty-seven percent were asymptomatic. Anal and conjunctival swabs tests resulted negative in all. Patients with lower body mass index (BMI) presented significantly higher viral loads. Main laboratory abnormalities were: lactate dehydrogenase increasing (73%), low vitamin D levels (87%), hematuria (33%), proteinuria (26%), renal hyperfiltration (33%), and hypofiltration (13%). Two of the patients with hyperfiltration exhibited high blood pressure levels at diagnosis, and persistence of prehypertension at 6-month follow-up. No abnormalities were seen at ultrasound, excepting for one patient who exhibited B-lines at lung sonography.Immunoglobulin G seroconversion was observed in all at 1-month.Conclusions: Our study confirm that intra-family transmission is important. The significant higher viral loads recorded among patients with lower BMI, together with low vitamin D levels, support the impact of nutritional status on immune system.Renal involvement is frequent even among children with mild COVID-19, therefore prompt evaluation and identification of patients with reduced renal function reserve would allow a better stratification and management of patients. Seroconversion occurs also in asymptomatic children, with no differences in antibodies titer according to age, sex and clinical manifestations.

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

“…Recent data reported several of these widespread long-term symptoms, i.e., fatigue, dyspnea, chest pains, muscle and joint pain, headache, insomnia, and palpitations, also in children and adolescent up to 6–8 months of follow-up ( 71 , 86 , 96 ). At 6 months of follow-up high blood pressure levels and persistence of a prehypertension were also detected in ~13% of mild COVID-19 children ( 82 ). Examining a larger cohort of children, it was also described that ~53–70% of these patients had at least one symptom 100 days or more after COVID-19 diagnosis ( 71 , 82 , 96 , 163 ).…”

“…At 6 months of follow-up high blood pressure levels and persistence of a prehypertension were also detected in ~13% of mild COVID-19 children ( 82 ). Examining a larger cohort of children, it was also described that ~53–70% of these patients had at least one symptom 100 days or more after COVID-19 diagnosis ( 71 , 82 , 96 , 163 ). Given these emerging data, recently, Hertting et al in an editorial on Acta Paediatrica underlined the need to have more research and studies on the long-term effects of COVID-19 in children and adolescents ( 164 ).…”

Serum IgG levels in children 6 months after SARS-CoV-2 infection and comparison with adults

“…There is a growing need to clarify these issues, considering the lowest susceptibility to COVID-19 of children compared with adult population [5][6][7][8][9][10][11][12][13]; therefore, study their immune response could be important to understand the mechanism capable of controlling the infection, and to provide further information for the development of successful surveillance strategies, therapies and vaccines.…”

Change in Pediatric Health Care Spending and Drug Utilization during the COVID-19 Pandemic

“…Primarily, along with a non-severe spread of SARS-CoV-2 infection in children [ 23 , 24 ], we observed a drastic reduction in the incidence of the main pediatric diseases caused by atopy and common seasonal bacteria and viruses. Not surprisingly, in 2020 the typical increase in consultations and hospital admissions for respiratory syncytial virus (RSV) and influenza viruses did not occur during the winter season [ 13 , 25 , 26 ].…”