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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: closed (25 July 2024) | Viewed by 20937

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Prof. Dr. Tina Q. Tan

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Guest Editor

1. Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Interests: pneumococcal infections; methicillin-resistant staphylococcus aureus infections (MRSA); pertussis (Whooping Cough) disease and vaccine; travel immunizations; international adoption; antibiotic resistance; vaccine preventable diseases

Special Issue Information

Dear Colleagues,

COVID-19 infections, caused by the coronavirus SARS-CoV-2 and its variants, emerged in December of 2019 in Wuhan, China and rapidly spread around the world; eventually, on 11 March 2020, the World Health Organization declared it a global pandemic. To date, there have been over 761 million cases and 6.9 million deaths that have occurred around the world. These numbers are felt to be significantly underestimated. In the United States, since the start of the pandemic, there have been over 102.5 million confirmed COVID-19 cases and over 1.1 million deaths. Based on US data, there have been over 15.5 million persons <18 years of age (pediatric population) who have been infected with SARS-CoV-2 and its variants, accounting for 18% of the COVID-19 cases. In this population, there have been 1750 deaths.

There is still ambiguity around COVID-19 infections in the pediatric population. There is a significant need to collect more age-specific data to assess the severity of illness, especially with different SARS-CoV-2 variants, and potential longer-term effects that COVID-19 infection has among children. This Special Issue will provide the most up-to-date resources on COVID-19 infections in the pediatric population, including information on the signs and symptoms of infection in different age groups; the immunology of COVID-19 infections; the sequelae of infections, including MIS-C (multisystem inflammatory syndrome) and long-term COVID; diagnosis and available treatment; and vaccines that are available for use in this population.

Prof. Dr. Tina Q. Tan
Guest Editor

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Keywords

COVID-19
children
MIS-C
long-term COVID

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Published Papers (9 papers)

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Research

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13 pages, 294 KiB

Open AccessArticle

The Impact of COVID-19 on Neuropsychological and Emotional-Behavioural Development in a Group of 8- and 9-Year-Old Children

by Angelica Marfoli, Giulia Speziale, Gaia Del Prete-Ferrucci, Harlan Cole, Angelica De Sandi, Denise Mellace, Daniela Chieffo, Sergio Barbieri, Alberto Priori, Bernardo Dell’Osso, Gabriella Pravettoni and Roberta Ferrucci

J. Clin. Med. 2024, 13(16), 4768; https://doi.org/10.3390/jcm13164768 - 14 Aug 2024

Cited by 1 | Viewed by 2836

Abstract

Introduction: The rapid spread of the COVID-19 pandemic has had a significant impact on the psychological well-being of millions of people around the world, and even more so among children. Contracting SARS-CoV-2, resulting in home confinement and restrictions on daily and school activities, led to negative effects on the mental health of the paediatric population. Although children suffering from COVID-19 had milder general symptoms compared to adults, impairments in cognitive, neuropsychological, and emotional-behavioural development were noted. Objective: The main aim of the present study was to detect possible changes in the neuropsychological and emotional-behavioural development of children after infection with the SARS-CoV-2 virus. The second aim was to investigate possible relationships between cognitive abilities and psychosocial characteristics. Methods: A total of 40 patients aged 8–9 years were recruited and divided into two groups: children who contracted (CG) and did not contract (NCG) SARS-CoV-2. The BVN 5–11 (Neuropsychological evaluation battery for developmental age from 5 to 11 years) instrument was administered to assess attention, memory, verbal recall, planning, phonemics, and categorical fluency domains in the paediatric population. Data on changes in emotional-behavioural profile and daily activities were collected through a questionnaire to parents. Results: The Wilcoxon signed-rank test revealed a significant change in mood after the COVID-19 period only in the CG participants (p = 0.019). However, the neuropsychological performance of the two identified groups on BVN 5–11 sub-items was below the cutoff of clinical significance. Correlations were found between sub-items of the BVN 5–11 battery, extracurricular activities, and children’s psycho-motor development. Significant positive correlations were observed between Naming on visual presentation and Reading time (p = 0.006), backward digit span and time of motor activity (p = 0.009), Visual attention and Reading time (p = 0.048), and Phonemic fluency and time observed using devices (p = 0.030). Positive statistically significant correlations were also found between Mood and Free behaviour (p = 0.000), between Mood and Structured behaviour (p = 0.005), and between Mood and peer Interaction (p = 0.013). Conclusions: SARS-CoV-2 infection negatively affected the emotional development of children contracting the virus. The neuropsychological functioning of the paediatric population was influenced by psychosocial variables and time spent on daily activities, which played a protective role in children’s cognitive development. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

15 pages, 1149 KiB

Open AccessArticle

COVID-19-Associated Multisystem Inflammatory Syndrome in Children and Cardiovascular Autonomic Control: A Prospective Cohort Study Nine Months after SARS-CoV-2 Infection

by Paolo Castiglioni, Susanna Rampichini, Carla Giuseppina Corti, Savina Mannarino, Gianvincenzo Zuccotti, Valeria Calcaterra, Damiano Formenti, Andrea Moriondo, Martina Anna Maggioni, Fabio Esposito and Giampiero Merati

J. Clin. Med. 2024, 13(14), 4163; https://doi.org/10.3390/jcm13144163 - 16 Jul 2024

Viewed by 1354

Abstract

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) has emerged as a severe pediatric complication during the SARS-CoV-2 pandemic, with potential long-term cardiovascular repercussions. We hypothesized that heart rate and blood pressure control at rest and during postural maneuvers in MIS-C patients, months after the remission of the inflammatory syndrome, may reveal long-term autonomic dysfunctions. Methods: We assessed 17 MIS-C patients (13 males; 11.9 ± 2.6 years, m ± SD) 9 months after acute infection and 18 age- (12.5 ± 2.1 years) and sex- (13 males) matched controls. Heart rate and blood pressure variability, baroreflex function, and hemodynamic parameters were analyzed in supine and standing postures. Results: MIS-C patients exhibited reduced heart rate variability, particularly in parasympathetic parameters during standing (pNN50+: 6.1 ± 6.4% in controls, 2.5 ± 3.9% in MIS-C; RMSSD: 34 ± 19 ms in controls, 21 ± 14 ms in MIS-C, p < 0.05), with no interaction between case and posture. Blood pressure variability and baroreflex sensitivity did not differ between groups except for the high-frequency power in systolic blood pressure (3.3 ± 1.2 mmHg² in controls, 1.8 ± 1.2 mmHg² in MIS-C, p < 0.05). The MIS-C group also showed lower diastolic pressure–time indices (DPTI) and systolic pressure–time indices (SPTI), particularly in standing (DPTI: 36.2 ± 9.4 mmHg·s in controls, 29.4 ± 6.2 mmHg·s in MIS-C; SPTI: 26.5 ± 4.3 mmHg·s in controls, 23.9 ± 2.4 mmHg·s in MIS-C, p < 0.05). Conclusions: Altered cardiovascular autonomic control may persist in MIS-C patients with, however, compensatory mechanisms that may help maintain cardiovascular homeostasis during light autonomic challenges, such as postural maneuvers. These results highlight the importance of assessing long-term cardiovascular autonomic control in children with MIS-C to possibly identify residual cardiovascular risks and inform targeted interventions and rehabilitation protocols. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

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14 pages, 257 KiB

Open AccessArticle

Diverse Parents Decision-Making to Vaccinate Their Child under Five Attending Childcare Programs

by Ernest St. John Thompson, Elizabeth Howe, Tara Kenworthy LaMarca, Ruby Natale and Jason F. Jent

J. Clin. Med. 2024, 13(8), 2299; https://doi.org/10.3390/jcm13082299 - 16 Apr 2024

Cited by 1 | Viewed by 1866

Abstract

Background: On 18 June 2022, Moderna and Pfizer-BioNTech COVID-19 vaccines were authorized under an Emergency Use Authorization by the United States Food and Drug Administration to prevent severe coronavirus disease in children six months to four years of age. Despite approval of the COVID-19 vaccinations for young children, there remain ongoing challenges reaching widespread coverage due to parental decision-making. Parental decision-making plays a pivotal, yet understudied, role governing vaccine adoption among this priority demographic. Methods: This cross-sectional analysis examined COVID-19 vaccine intentions for 320 predominately Hispanic parents of two to five-year-olds attending Miami-Dade County childcare programs in Florida USA, several months following the June 2022 emergency authorization. Parent’s self-reported survey data encompassed vaccine choices and rationales, social determinants of health, and parent immigrant status. Data analyses illustrate the associations between parent decision-making and these variables. Regression modeling and tests of independence identified predicting factors for parental vaccine decision-making. Results: Only 25% of parents intended to vaccinate their young child, while 34% resisted and 41% felt unsure, despite 70% personal vaccination rates. Household income under $25,000, identifying as a migrant, or testing COVID-19-positive significantly predicted unsure decision-making. The majority of hesitant groups expressed concerns around side effects (20%), safety (2.9%), and sufficiency of vaccine knowledge (3.3%). Conclusions: In this sample, the predominance of parents were unsure and resistant rather than accepting of having their child vaccinated despite emergency approval of the pediatric vaccine. Associations and predictive factors are examined. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

12 pages, 1015 KiB

Open AccessArticle

Effect of Water-Based vs. Land-Based Exercise Intervention (postCOVIDkids) on Exercise Capacity, Fatigue, and Quality of Life in Children with Post COVID-19 Condition: A Randomized Controlled Trial

by Anna Ogonowska-Slodownik, Marta Kinga Labecka, Agnieszka Maciejewska-Skrendo, Renae J. McNamara, Katarzyna Kaczmarczyk, Michał Starczewski, Jan Gajewski and Natalia Morgulec-Adamowicz

J. Clin. Med. 2023, 12(19), 6244; https://doi.org/10.3390/jcm12196244 - 28 Sep 2023

Cited by 2 | Viewed by 2936

Abstract

Evidence suggests that COVID-19 can cause lasting health consequences called post-COVID-19 condition. We conducted a three-group, randomized controlled trial for children aged 10–12 years with post COVID-19 condition. Participants were randomized to AQUA, LAND, or CONTROL groups. The AQUA and LAND training sessions were conducted twice a week for eight weeks. The primary outcomes were exercise capacity, measured using the modified Balke treadmill protocol, and fatigue, measured using the Cumulative Fatigue Symptoms Questionnaire (CFSQ). The secondary outcome was health-related quality of life (HRQoL), measured with the Pediatric Quality of Life Inventory (PedsQL) for children and parents. A total of 74 of the 86 children completed the intervention and attended the post-intervention assessment. The absolute maximal oxygen uptake (VO₂max) values increased after both AQUA (p = 0.001) and LAND (p = 0.004) interventions. No significant differences were found in the degree of total fatigue and individual fatigue symptoms. A significant improvement was found in the PedsQL reported by the parents in the LAND group. In conclusion, the applied eight-week water-based and land-based exercise training programs improved exercise capacity in children aged 10–12 years old with post COVID-19 condition. The parents of the children in the training groups also noted an improvement in HRQoL. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

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Review

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11 pages, 267 KiB

Open AccessReview

Navigating the Spectrum of Two Pediatric COVID-19 Complications: Multi-System Inflammatory Syndrome in Children and Post-Acute Sequelae of SARS-CoV-2 Infection

by Simon Parzen-Johnson and Ben Z Katz

J. Clin. Med. 2024, 13(4), 1147; https://doi.org/10.3390/jcm13041147 - 18 Feb 2024

Cited by 5 | Viewed by 1806

Abstract

Purpose: This review summarizes the current scope of understanding associated with two common post-infectious complications associated with COVID-19 infection: Multi-System Inflammatory Syndrome in Children (MIS-C) and Post-Acute Sequelae of SARS-CoV-2 infection (PASC). It identifies current gaps in the knowledge and issues that may limit the ability to fill these gaps. This review provides a framework to drive continued research. Methods: A comprehensive review of the current literature was performed, identifying seminal articles describing the emergence of MIS-C and PASC, and works from the literature focused on the clinical implications and pathophysiologic understanding of these disorders. Findings: Although pediatric patients experienced few severe cases of acute COVID-19 infection, the burden of disease from post-infectious sequelae is substantial. Mortality is low, but morbidity is significant. There are still numerous unknowns about the pathophysiology of both MIS-C and PASC; however, with widespread immunity developing after increased vaccination and prior infection, it may be difficult to perform adequate prospective studies to answer pathophysiologic questions. Long-term sequalae of MIS-C seem to be minimal whereas, by definition, PASC is an ongoing problem and may be severe. Implications: The rapid sharing of information regarding novel conditions such as MIS-C and PASC are key to interventions related to future post-infectious sequelae outside of those stemming from COVID-19. Although MIS-C seems unlikely to return as a clinical condition in substantial numbers, there is still significant learning that can be gleaned from existing patients about general aspects of epidemiology, equity, and pathophysiology. There is significant morbidity associated with PASC and additional resources need to be dedicated to determining appropriate and effective therapies moving forward. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

12 pages, 259 KiB

Open AccessReview

Overview of COVID-19 Infection, Treatment, and Prevention in Children

by Carol M. Kao

J. Clin. Med. 2024, 13(2), 424; https://doi.org/10.3390/jcm13020424 - 12 Jan 2024

Cited by 3 | Viewed by 3069

Abstract

Coronavirus disease 2019 (COVID-19), caused by the novel respiratory virus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—was declared a global pandemic by the World Health Organization on 11 March 2020. Since then, substantial gains have been made in our understanding of COVID-19 epidemiology, disease presentation, and management. While children tend to have less severe disease courses compared to adults, children can still develop severe COVID-19 infections, particularly in those with underlying medical conditions such as obesity, chronic lung disease, or prematurity. In addition, children are at risk of severe complications of COVID-19 infection, such as multisystem inflammatory syndrome in children (MIS-C) or long COVID. The case definitions of MIS-C and long COVID have continued to evolve with the increased understanding of these new entities; however, improved methods of diagnosis and determination of the optimal management are still needed. Furthermore, with the continued circulation of SARS-CoV-2 variants, there remains a need for clinicians to remain up-to-date on the latest treatment and prevention options. The purpose of this review is to provide an evidence-based review of what we have learned about COVID-19 in children since the start of the pandemic and how best to counsel children and their families on the best methods of prevention. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

11 pages, 532 KiB

Open AccessReview

Differences in the Clinical Manifestations and Host Immune Responses to SARS-CoV-2 Variants in Children Compared to Adults

by Salih Demirhan, David L. Goldman and Betsy C. Herold

J. Clin. Med. 2024, 13(1), 128; https://doi.org/10.3390/jcm13010128 - 26 Dec 2023

Cited by 4 | Viewed by 2151

Abstract

The COVID-19 pandemic challenged the medical field to rapidly identify and implement new approaches to the diagnosis, treatment and prevention of SARS-CoV-2 infections. The scientific community also needed to rapidly initiate basic, translational, clinical and epidemiological studies to understand the pathophysiology of this new family of viruses, which continues to evolve with the emergence of new genetic variants. One of the earliest clinical observations that provided a framework for the research was the finding that, in contrast to most other respiratory viruses, children developed less severe acute and post-acute disease compared to adults. Although the clinical manifestations of SARS-CoV-2 infection changed with each new wave of the pandemic, which was dominated by evolving viral variants, the differences in severity between children and adults persisted. Comparative immunologic studies have shown that children mount a more vigorous local innate response characterized by the activation of interferon pathways and recruitment of innate cells to the mucosa, which may mitigate against the hyperinflammatory adaptive response and systemic cytokine release that likely contributed to more severe outcomes including acute respiratory distress syndrome in adults. In this review, the clinical manifestations and immunologic responses in children during the different waves of COVID-19 are discussed. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

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10 pages, 239 KiB

Open AccessReview

The Therapy of SARS-CoV-2 Infection in Children

by Kathryn M. Edwards

J. Clin. Med. 2024, 13(1), 120; https://doi.org/10.3390/jcm13010120 - 25 Dec 2023

Cited by 1 | Viewed by 1952

Abstract

The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided. Full article

(This article belongs to the Special Issue Pediatrics and COVID-19)

14 pages, 282 KiB

Open AccessReview

COVID-19 Vaccines in Children

by Danielle Fayad and Robert W. Frenck, Jr.

J. Clin. Med. 2024, 13(1), 87; https://doi.org/10.3390/jcm13010087 - 23 Dec 2023

Cited by 4 | Viewed by 2000

Abstract

The COVID-19 pandemic has left an indelible mark on global health, affecting individuals of all ages across diverse communities. While the virus has predominantly been associated with severe outcomes in adults, its impact on children has garnered increasing attention. Today, three COVID-19 vaccines are available for use in the U.S. and recommended by the Advisory Committee on Immunization Practices (ACIP). As of September 2023, ongoing genomic surveillance identified SARS-CoV-2 XBB sublineages as the most common circulating SARS-CoV-2 variants, constituting over 99% of sequenced SARS-CoV-2 specimens in the US. Recently, recommendations for COVID-19 vaccination were updated accordingly to the 2023–2024 Omicron-XBB.1.5-adapted monovalent COVID-19 vaccine to provide heightened protection against currently circulating SARS-CoV-2 XBB-sublineage variants. COVID-19 vaccines have proven to be safe, efficacious, and effective at protecting against COVID-19 and preventing severe illness in children and adolescents. Full article

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