Rehospitalization indications of children hospitalized for COVID-19 infections after discharge: Should we suspect long COVID?

BACKGROUND: Complications that may develop in children after coronavirus disease 2019 (COVID-19) infections are unknown. The `Long COVID` syndrome is a new process that can also be identified in children. Therefore, in this study, the conditions that may develop in children after COVID-19 infection were discussed, and the indications for rehospitalizations were reviewed. METHODS: This retrospective cohort study was conducted in a tertiary children`s hospital in Izmir, Türkiye. All children who were rehospitalized in the study center after discharge, and the indications for readmissions were screened. RESULTS: Since the beginning of the pandemic, 777 children with COVID-19 infection were hospitalized, including 98 (12.6%) cases rehospitalized for any indication. Fifty-five (56.1%) patients were male, and 43 (43.9%) were female. The mean age of the study population was 79.3±63.5 months (1 month to 17 years). Among these 98 patients, 76 (77.6%) were rehospitalized because of the presence of their primary underlying disease, nonspecific infectious diseases unrelated to COVID-19, and the need to perform certain surgical procedures. The remaining 22 (22.4%) patients presented with symptoms such as fatigue, fever, abdominal pain, and myalgia after the COVID-19 infection. No other underlying cause was detected in approximately one-third of the patients, whose manifestations were found to be consistent with long COVID syndrome. CONCLUSIONS: The findings of acute COVID-19 infection are well characterized, but there is still limited data on its long-term outcomes. The majority of the study population that had no underlying disease were thought to have complications from the COVID-19 infection. Therefore, although the incidence rate of long COVID syndrome in childhood has not been revealed so far, it should be kept in mind among relevant differential diagnoses.

Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features.

Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2-4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2-6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients' MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2-6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.

Characteristics of pediatric COVID-19 patients admitted to the emergency department and factors associated with pneumonia.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) that causes a respiratory illness, continues to be a global pandemic. In this study, we purpose to identify the features of children with COVID-19 and the factors affecting disease severity. METHODS: This is a retrospective, observational study was conducted on patients who presented with suspicion of COVID-19 from April 1, 2020, to March 31, 2021, at a tertiary care medical center in Turkey. The characteristics of 640 children who were confirmed to have COVID-19 by real-time reverse transcription-polymerase chain reaction were retrieved from medical records. RESULTS: The mean age of the cases was 10 ± 6 years, and 56% of them were male. Seasonal difference did not affect the number of cases. The majority of the cases (n = 501, 78%) were infected by family members. Fever (67%) and cough (38%) were common complaints. The mean duration of fever was 1.9 ± 1.1 days. One-fourth of the cases were asymptomatic, 462 (72%) had mild upper respiratory tract infections, and 18 (3%) had pneumonia. Patients with pneumonia were more likely to have comorbidities and had a longer fever duration (both P < 0.001). Fever, cough, and respiratory distress were more common in patients with pneumonia (P = 0.010, P = 0.023, and P < 0.001, respectively). The mean C-reactive protein (CRP) value of the patients with pneumonia was significantly higher than that of the others (P < 0.001). A total of 70 (11%) complicated patients were hospitalized, 5 of them requiring intensive care admission. All hospitalized patients were discharged with recovery. CONCLUSIONS: Although pediatric COVID-19 patients tended to have a mild disease, some children with comorbidities can still develop a severe illness. CRP value is a useful indicator in the diagnosis of COVID-19 pneumonia. Furthermore, the prevalence rate of COVID-19 did not decrease with hot seasons.

The first pediatric case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with Neisseria meningitidis.

BACKGROUND: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinic-radiological syndrome characterized by neurological deficiencies and reversible magnetic resonance imaging findings in the splenium of the corpus callosum. Usually, it has a good prognosis, and patients recover without any sequelae. A viral infection has caused most MERS cases, and bacterial agents have rarely been reported as a cause of MERS. CASE REPORT: A 5-month-old male was admitted to the hospital with fever, poor feeding, decreased activity and groaning. He had focal seizures and required mechanical ventilation. A lumbar puncture was performed, and nucleic acid amplification tests (NAATs) of cerebral spinal fluid was positive for non-typeable serogroup of Neisseria meningitidis. Cranial magnetic resonance imaging (MRI) performed on day 3 of admission showed T2 hyperintensity and diffusion restriction at the splenium of corpus callosum (SCC). Diffusion restriction in the occipital horn of the left ventricular compatible with empyema was also obvious. According to the findings on cranial MRI, this clinical course was diagnosed as MERS associated with meningitis. His fever resolved in one week, cefotaxime was discontinued after 14 days, and the patient completely recovered. A follow-up MRI performed after three weeks of admission showed complete resolution of the signal intensity changes in the SCC and the occipital horn of the left lateral ventricle. CONCLUSION: To the best of our knowledge, this is the first report of MERS associated with Neisseria meningitidis in children. Bacterial agents as a cause of MERS should be kept in mind, and we should avoid unnecessary treatment strategies due to the good prognosis of MERS in children.