COVID-19, MIS-C, and Long COVID in Pediatric Patients: An Update

Enlarge Image
Delivery Method:	Online
$59.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: July 2024 (Volume 21, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 07/01/2027.

Authors

Peer Reviewers

Abstract

COVID-19, the disease caused by SARS-CoV-2, has been disruptive worldwide. It was primarily a respiratory disease that affected many of the medically vulnerable, but the true impact of postacute sequelae of SARS-CoV-2 (PASC), which has been demonstrated to involve all organ systems, is now coming to light. In addition, a new disease entity emerged, multisystem inflammatory syndrome in children (MIS-C), which has had significant morbidity and mortality associated with it. This issue reviews the presentation, evaluation, and management of patients with COVID-19, MIS-C, and PASC. Additionally, the current literature supporting public health measures, as well as COVID-19 vaccinations and their complications are discussed.

Case Presentations

A 14-year-old boy with no pre-existing medical conditions presents with fever, diarrhea, and abdominal pain for 4 days...

• A diffuse maculopapular rash started 2 days ago, and bilateral eye redness started today. The boy is reporting weakness and looks mildly dehydrated.
• The boy’s vital signs are: temperature, 38.6°C; heart rate, 134 beats/min; blood pressure, 100/45 mm Hg; respiratory rate, 20 breaths/min; and pulse oximetry, 98%. He has not traveled out of the country. He reports a diagnosis of COVID-19 3.5 weeks ago, along with other members of his family.
• What is your initial management of this patient? Is the COVID-19 history relevant?

A 4-year-old girl with no significant past medical history presents to the pediatric ED with cough, congestion, and fever for 2 days...

• The girl had a maximum temperature of 39.4°C. The mother says she is concerned about the possibility of COVID-19. They live in a multigenerational home, and 2 grandparents are currently hospitalized with COVID-19. The mother thinks tests should be performed to assure she “will not get intubated like her grandparents.”
• The patient’s vital signs are temperature, 39.1°C; heart rate, 128 beats/min; blood pressure, 90/52 mm Hg; respiratory rate, 26 breaths/min; and pulse oximetry, 97%. A physical examination reveals a well-appearing, well-hydrated child in no respiratory distress. You note nasal congestion, a coarse cough, and clear lung sounds.
• Does her exposure to COVID-19 change your management plan? What are the risk factors for severe COVID-19 that you should be considering?

A 9-day-old boy is brought to the ED with a fever for 1 day, with a maximum temperature of 38.4°C...

• The mother is recovering from COVID-19 that was diagnosed 1 day before an uncomplicated vaginal delivery. Her only symptom was a scratchy throat. The Apgar scores were 8 at 1 minute and 9 at 5 minutes. The baby stayed with the mother in her room and was discharged <2 days later. The baby’s birth weight was 7 lbs 2 oz, and he currently weighs 7 lbs 5 oz.
• The boy’s vital signs are: temperature, 38.9°C; heart rate 168 beats/min; blood pressure, 72/46 mm Hg; respiratory rate, 50 breaths/min; and pulse oximetry, 96%. The physical examination reveals a crying but consolable child with clear rhinorrhea, nasal congestion, and intermittent coughing, but is otherwise normal. The mother is tearful and very nervous about the possible effects of COVID-19 on her baby.
• Does the patient's age affect your decision-making? What are the concerns with COVID-19 infection in a newborn? What are the outcomes for neonatal COVID-19 infections?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.