ABSTRACT
Background: We present the case of a 7-year-old girl (15 kg and 135 cm) with SARS-CoV-2 infection who developed severe heart failure due to myocarditis and acute respiratory distress syndrome resulting in multisystem inflammatory syndrome in children (MIS-C) requiring extracorporeal membrane oxygenation (ECMO) support. Method: Due to a massively dilated left ventricle (LV), LV unloading was required. The only appropriate treatment for such a petite child was off-label implantation of the smallest available impeller microaxial flow pump. After placement in the LV, a flow of 0.9 to 1.1 L/min could be generated. A significant improvement of hemodynamics and sufficient unloading of the LV was observed. The impeller pump could be removed 6 days after initial implantation. Sadly, the medical condition of the child deteriorated due to COVID-19-associated MIS-C, therapy was ceased, and the patient died in multiorgan failure. Results and Conclusion: The combination of venoarterial ECMO (VA-ECMO) and concomitant impeller pump implantation (ECMELLA) for left ventricular unloading in adult patients with cardiogenic shock has already been advocated to improve outcome. Due to the relatively large dimensions of already existing microaxial pumps (for adults), the introduction of ECMELLA in children with severe cardiovascular failure is still a long way off. Smaller devices adjusted to pediatric parameters and proportions should be developed as soon as possible for better treatment of children in need of mechanical support. This would be of great interest and an enormous benefit for both patients and physicians.
ABSTRACT
Background: In response to the pandemic, closure of daycare facilities has been implemented as part of infection control, jeopardizing children's education. Whether these measures proved effective, remains up for discussion. This study aimed at understanding how the behavior of families influenced the probability of acquiring the virus in children with chronic cardiovascular (CV) health conditions. Method: The “COVID-19 Child Health Investigation of Latent Disease” study screened 6,113 children of less than 18 years in pediatric hospitals and among healthy volunteers in Hamburg from May 9 to June 30, 2020. Participants were tested for SARS-CoV-2 infection by nasopharyngeal PCR. Of them, 4,657 participants were tested for antibodies against SARS-CoV-2. The family's social and psychological situation and medical history were assessed via questionnaire. Results: A total of 6,113 (age 7.7 ± 5.1 years) patients were included in the study of which 27.3% had at least one chronic health condition. Also, 219 children (16.2%) had a CV disease. While no active infection on PCR was detected, seropositivity rate amounted to 1.3%. The seropositivity rate did not differ between the population with chronic health conditions and the healthy population (1.0 vs.1.4%, p = 0.271). Parents of children with chronic health conditions more often reported worries regarding the health risk of the virus to their children (30.9 vs. 12.6%, OR = 3.1 [2.7-3.6], p < 0.001) and were less likely to have sent their children to an educational institution 14 days before the testing (48.3 vs. 67.2%, age-adjusted OR = 0.38 [0.33-0.43], p < 0.001). We did not observe increased odds of seropositivity when visiting educational institutions in the 14 days before testing (age-adjusted OR = 1.03 [0.61-1.76], p = 0.902). Increased physical burden of the caregiver and their assessment of their child's worse well-being correlated with increased seropositivity (OR = 2.7 [1.4-5.3], p = 0.004, and 3.3 [1.2-9.5], p = 0.021). Conclusion: The prevalence of SARS-CoV-2 in children with and without chronic health conditions is similar. Still, the anxiety in parents of sick children is higher, which leads to a reduced attendance of daycare facilities. Attendance at a daycare facility does not increase the risk of seropositivity in children with health conditions. Caregivers' assessment of the physical well-being in their child is a good predictor of seropositivity. In summary, the spread of SARS-CoV-2 seems to be limited in daycare facilities even in chronically sick children with CV disease.