COVID-19 in pediatrics: case report with many complications and a good clinical outcome

Coronavirus disease 2019 (COVID-19) is an acute infectious disease that caused the emergence of the new serious global pandemic. The infection in children is much less prevalent than in adults and most cases are asymptomatic or have mild symptoms. Severe cases represent less than 1% of the total, therefore information about the disease in this age group is scarce compared to data in older individuals. We exposed a case of a 16-year-old male adolescent with a previous diagnosis of myelomeningocele, hydrocephalus with peritoneal ventricle bypass (PVB), recurrent urinary tract infection, epilepsy, and obesity. The patient presented cough and convulsive crises, which worsened during hospitalization with severe acute respiratory syndrome due to SARS-CoV-2, septic shock, and cardiorespiratory arrest and invasive mechanical ventilation (IMV) for 9 days was required. Also presented several other complications and factors of critical prognosis, such as elevated inflammatory markers (C-reactive protein, D-dimer), elevated cardiac troponin, and the necessity of renal replacement therapy. Nevertheless, the clinical outcome was satisfactory and he was discharged after a 40-day stay in the Pediatric Intensive Care Unit.

How COVID-19 quarantine might affect the sleep of children and adolescents?

OBJECTIVES: To describe the main aspects of altered sleep in children and adolescents in the quarantine of COVID-19. METHODS: A narrative review of the current literature on the topic was carried out, based on the most recent national/international classification. RESULTS: The literature on the subject is still scarce. The sudden changes in routines and transfers of classes to virtual models provided flexibility in school activities, impacting the circadian rhythm of children and adolescents and, consequently, sleep. As a result, the lack of a routine with pre-established schedules by parents, results in longer use of electronic devices, from games to the media. CONCLUSIONS: It is essential that pediatricians advise parents on the importance of establishing a routine of daytime and nighttime activities, which will have an impact on the quality of sleep of children and adolescents during this quarantine period.

Cutaneous manifestations in a patient with temporarily associated pediatric multisystemic inflammatory syndrome with COVID-19: case report

OBJECTIVES: To describe the cutaneous manifestations presented by a patient with pediatric multisystemic inflammatory syndrome (MIS-C) temporarily associated with SARS-CoV-2. METHODS: Female patient, 10 years old, presenting arthralgia in the wrists and ankles, edema in hands and feet, persistent fever, appearance of diffuse, and itchy maculopapular rash associated with odynophagia and productive cough. Evolution of the rash to violaceous lesions on the face, trunk and limbs (upper and lower), in addition to the appearance of vesicles on the face, within 48 hours. CBC suggestive of an infectious condition, with CRP 307mg/L (insert reference value) and ESR 61mm. RT-PCR for SARS-CoV-2 positive. RESULTS: Diagnosis of pediatric multisystemic inflammatory syndrome temporarily associated with SARS-CoV2. Transferred to ICU for monitoring and intravenous human immunoglobulin initiated. Good evolution, with the disappearance of injuries and discharge with outpatient follow-up. CONCLUSION: MIS-C has several dermatological manifestations and pediatricians must be attentive to the diagnosis, not limited to a specific presentation. In this case report, the importance of referral to tertiary referral centers for better case management and timely recognition of the syndrome in these patients is emphasized.

Multisystem Inflammatory Syndrome In Children (MIS-C) Temporally Associated With COVID-19 - An Update

INTRODUCTION: Children are less likely to have severe acute COVID-19, but cases of pediatric multisystem inflammatory syndrome (PIMS) with possible temporal association with previous SARS-CoV-2 infection have been described. OBJECTIVES: Non-systematic review of the literature on epidemiology, pathophysiology, diagnosis, and treatment of PIMS. SOURCE OF DATA: PubMed database, scientific documents of the Brazilian Society of Pediatrics, World Health Organization, Centers for Disease Control and Prevention (CDC), and Royal College of Pediatrics and Child Health. SUMMARY OF FINDINGS: PIMS shares characteristics with Kawasaki disease, toxic shock syndrome, bacterial sepsis and cytokine storm syndrome. It is more frequent in Afrodescendants and Hispanics, schoolchildren and adolescents, and in males. It occurs 2-4 weeks after SARS-CoV-2 infection. Pathophysiology involves direct effects of the virus and/or post-COVID-19 immune dysregulation. The clinical presentation is heterogeneous, fever being very frequent, followed by gastrointestinal, cardiovascular, respiratory, neurological, and renal manifestations. Thorough anamnesis and physical examination, as well as complementary exams to assess inflammatory process, organ involvement and the relationship with SARS-CoV-2 infection (RT-PCR and serology), are essential. Diagnostic criteria proposed by the CDC and WHO support the diagnosis. Treatment must be coordinated by a team of specialists, and directed to inflammatory and organic manifestations. CONCLUSIONS: PIMS is characterized by a broad clinical spectrum, with fever, gastrointestinal, neurological manifestations, shock, and myocardial dysfunction. It requires a high degree of suspicion for early treatment and prevention of potential cardiovascular, respiratory, renal, and neurological complications.

The Pediatric Residency journal and the dissemination of information in times of COVID-19

OBJECTIVES: To present the procedure adopted by the PR journal on providing quick and agile visualization of the content of articles on COVID-19, sent and accepted for publication, immediately after being approved by the reviewers. METHODS: Preparation of a copy specially focused on COVID-19 themes, with the establishment of a priority flow to speed up the peer reviews of the submitted manuscripts. RESULTS: Readers benefit from the opportunity to read relevant topics in advance, which will still require a certain amount of time to be made available, given the routine of the entire publishing process. CONCLUSIONS: A simple initiative, such as the “pre-publication visualization”, may serve as a stimulus for other open access journals to follow this simplified model, expanding the communication network between researchers.

Lethality by COVID-19 in children: an integrative review

OBJECTIVES: To characterize the clinical and epidemiological characteristics of deceased pediatric patients with COVID-19. METHODS: It was performed an integrative literature review with the keywords “children”, “COVID-19” and “death” and the boolean “AND” on the databases SciELO, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Embase and ScienceDirect. The results were filtered by publication date (January 1st to June 30th) and by language (Portuguese, English and Spanish). The inclusion criteria were: articles with proven or probable pediatric COVID-19 cases and full text in Portuguese, English or Spanish. Articles with no full text available in the above-mentioned languages, non-pediatric population and editorials were excluded. Brazilian data were analyzed based on epidemiological reports from each state of the country. RESULTS: 24 articles were analyzed, with a total of 17 deaths among pediatric COVID-19 patients. There was no data available about age of 9 patients and about comorbidities of 14 patients. Brazil had 357 pediatric deaths and 182 of them were on the age group 0-9 years. The most frequent comorbidities were heart disease and diabetes. CONCLUSIONS: Despite the low distribution of deaths among pediatric COVID-19 patients, it is important to point out that they are still carriers of the disease.

Pediatric type 1 diabetes mellitus and COVID-19 infection: is there an association?

A recent study from the UK, has described an apparent increase in new type 1 diabetes (T1DM) onset in children during COVID-19 pandemic. Both Brazil and USA (including our area of Houston, TX) have recently suffered from a sudden surge of this infection and we have noticed an association between the infection and 2 new cases of pediatric diabetes presenting in diabetes ketoacidosis. This association may become important in the future if the epidemiological data of T1DM shows an increased trend post the COVID-19 infection. It is also important to note that one patient was asymptomatic, this may be important to consider early screening and diagnosis to prevent the spread of infection.

COVID-19 physiotherapeutic approach in pediatrics: literature review

OBJECTIVES: To present the main characteristics, diagnosis and physiotherapeutic approach of pediatric patients infected with COVID-19. METHODS: This is an integrative literature review carried out from February to June 2020 regarding the physiotherapeutic approach in children diagnosed with COVID- 19. The search was performed in the PubMed database with the keywords “coronavirus”, “pediatric”, and “physiotherapy” crossed by through the boolean “AND” operator in the past four months. Articles that addressed only the subtype COVID-19 in pediatric patients were included and duplicate articles were excluded. In addition, research was carried out on protocols/articles from the Ministry of Health and Associations. RESULTS: 273 articles were found in the PubMed database; however, 25 were included according to the selection criteria previously determined, in addition to 1 articles/association protocols that were also included. CONCLUSIONS: It was verified through this integrative review that the main characteristics of pediatric patients infected by COVID-19 are: mean age of involvement of 7 years; transmission by direct and/or indirect contact with respiratory droplets; different pathophysiology of adults due to different immune response; and mild symptoms with a good prognosis. The diagnosis is given by the clinical picture and categorized by severity: asymptomatic, mild, moderate, severe, and very serious. Among the proposed approaches, the following stand out: oxygen therapy, invasive mechanical ventilation, maintenance of the elevated headboard (30º-45º), prone position, and early mobilization.