COVID-19 Pediatric Problems: A Narrative Review

Main Article Content

Tiffany Field, PhD

Abstract

     COVID-19 pediatric problems have been similar to those for adults, including medical, neurological, sensory and psychological conditions, although they have typically been less prevalent and severe. The lesser severity in children may relate to their less mature viral receptors, less dysregulation of immune responses, and a lesser incidence of pre-existing comorbid conditions. This narrative review is a summary of publications found on PubMed for 2019-2021 on the prevalence of infection and the characteristics of the clinical condition that has predominated for children (multisystem inflammatory syndrome typically presenting with fever and cough in 1-5% of children between the ages of 1 and 14). Most of the extra-pulmonary symptom literature has focused on neurological, sensory and psychological conditions including headaches and loss of smell and taste as well as skin problems. The research on psychological symptoms has noted helplessness, worry and fear as well as more serious problems including anxiety, depression, PTSD symptoms and suicidal ideation. These problems have been attributed to less exercise, separation from schools and peers, over-exposure to social media, already existing psychiatric disorders and chronic illnesses that have been exacerbated by COVID-19. Methodological limitations of the literature include small sample, cross-sectional studies assessing single variables in countries that experienced lockdowns early in the pandemic. And, sequelae or post-COVID problems have rarely been researched.


This narrative review was intended to be a brief overview of publications on medical, neurological, sensory and psychological problems that children and adolescents have experienced during COVID-19. The review is based on some of the larger sample studies and systematic reviews that appeared on PubMed for the years 2019-2021. The terms pediatrics, children, adolescents and COVID-19 were entered and the search yielded 173 papers. Inclusion criteria were peer-reviewed studies and systematic reviews. Case reports and non-English papers were excluded. Following these criteria, 57 papers were selected. The resulting review that reflects the current literature includes prevalence data, clinical characteristics and potential underlying mechanisms. Consistent with the aims of this review, the paper is divided into sections on medical, neurological, sensory and psychological conditions as well as COVID-19 sequelae.

Article Details

How to Cite
FIELD, Tiffany. COVID-19 Pediatric Problems: A Narrative Review. Medical Research Archives, [S.l.], v. 9, n. 5, may 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2426>. Date accessed: 28 oct. 2021. doi: https://doi.org/10.18103/mra.v9i5.2426.
Section
Research Articles

References

1. Akhtar H, Patel C, Abuelgasim E, Harky A. COVID-19 (SARS-CoV-2) Infection in Pregnancy: A Systematic Review.Gynecol Obstet Invest. 2020; 85(4):295-306. doi: 10.1159/000509290.
2. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020.37(8):861-865. Doi:19, 1055/s-0040-1710050.
3. Andina D, Belloni-Fortina A, Bodemer C et al; Chilblains in children in COVID-19ESPD Group for the Skin Manifestations of COVID-19.Clin Exp Dermatol. 2020. doi: 10.1111/ced.14481.
4. .Andina D, Noguera-Morel L, Bascuas-Arribas M, et al.Skin manifestations of COVID-19 in children: Part 1.A.Pediatr Dermatol. 2020; 37(3):406-411.
doi: 10.1111/pde.14215.
5. Andina D, Belloni-Fortina A, Bodemer C, et al. Group for the Skin Manifestations of COVID-19 in children: Part 2 .Clin Exp Dermatol. 2020. doi: 10.1111/ced.14482.
6. Andina D, Belloni-Fortina A, Bodemer C, et al ESPD Group for the Skin Manifestations of COVID-19.Clin Exp Dermatol. 2020. doi: 10.1111/ced.14483.
7. Bellan M, Soddu D, Balbo PE, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open. 2021; doi:10.1001/jamanetworkopen.2020.36142.
8. Borsette, D., Hopkins C, Philips V, et al. Self-reported alteration of sense of smell or taste in patients with COVID-19: a systematic review and meta-analysis on 3563 patients. Rhinology. 2020; 58(5):430-436. doi: 10.4193/Rhin20.
9. Buonsenso D, Costa S, Sanguinetti M. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol. 2020. 37 (8):869-872. doi: 10,1055/s-0040-1710541.
10. Caffo, E., Scandroglio, F, & Asta, L Debate: COVID-19 and psychological well-being of children and adolescents in Italy. 2020; 25(3):167-168 doi: 10.1111/camh.12405.
11. Conchero-Guisan, A. et al. Subtle olfactory dysfunction after SARS-CoV-2 virus infection in children, Otorhinolaryngology, 2021.
Doi: org/10.1016/J. IJPORL.2020.110539.
12. Cui X, Zhao Z, Zhang T, et al A systematic review and meta analysisof children with coronavirus disease 2019 (COVID-19).J Med Virol. 2021; 93(2):1057-1069. doi: 10.1002/jmv.26398.
13. de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB. Clinical manifestations of children with COVID-19: A systematic review. Pediatr Pulmonol. 2020; 55(8):1892-1899. doi: 10.1002/ppul.24885.
14. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020; 145(6): doi: 10.1542/peds.2020-0702 32179660.
15. Erdede O, Sarı E, Uygur Külcü N, Uyur Yalçın E, Sezer Yamanel RG. An overview of smell and taste problems in paediatric COVID-19 patients. Acta Paediatr. 2020; 109 (11):2184-2186.
doi: 10.1111/apa.15515.
16. Field, T Smell and Taste Dysfunction as Early Markers for Neurodegenerative and Neuropsychiatric Diseases. Journal of Alzheimer’s Disease and Parkinsonism; 2015; 5, 1-9.
17. Field, T, Mines, S, Poling, S, Bendell, D Veazey, C. Stressors and buffers during a COVID-19 lockdown: A narrative review. American Journal of Psychiatric Research and Reviews, 2021.
18. Gallus, N Roberto, S et al. Audiovestibular Symptoms and Sequelae in COVID-19 Patients. Journal of Vestibular Research. 2021: 1 – 7.
19. Han Y, Ma H, Suo M, et al. Clinical manifestation, outcomes in pregnant women with COVID-19 and the possibility of vertical transmission: a systematic review of the current data. J Perinat Med. 2020; 48(9):912-924. doi: 10.1515/jpm-2020-0431.
20. Hu X, Gao J, Luo X. et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission in neonates born to mothers with coronavirus disease. 2019 (COVID-19) pneumonia. Obstet Gynecol. 136 (1): 65-67. doi:10,1097/AOG.00000000003926.
21. Huntley , BJ, Huntley ES, Di Mascio, D, Chen, T, Berghella, V, Chauhan, S. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review2020 136(2):303-312.
doi: 10.1097/AOG.0000000000004010.
22. Ibekwe TS, Fasunla AJ, Orimadegun AE. Systematic Review and Meta-analysis of Smell and Taste Disorders in COVID-19.OTO Open. 2020; 4(3): doi: 10.1177/2473974X20957975.
23. Jieru L , Asfour A Sewell B, et al Neurological issues in children with COVID-19Neurosci Letters.2021 743: doi: 10.1016/j.neulet.2020.135567.
24. Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2020; 39(11): 340-346. doi:10.1097/INF.0000000000002888.
25. Koné-Paut I, Cimaz R. Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantics in the era of COVID-19 pandemic Rheumatic and muscular diseases, 2020, 6 (2): doi: 10.1136/rmdopen-2020-001333.
26. Larenas-Linnemann D, Luna-Pech J, Navarrete-Rodríguez E, et al Cutaneous manifestations related to COVID-19 immune dysregulation in the pediatric age group.2021, Curr Allergy Asthma Ewp, 21, 13, doi: 10.1007/s11882-020-00986-6.
27. Lee DS, Mirmirani P, McCleskey PE, et al. Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health. Psychiatry Res. 2020; 290:113172. doi: 10.1016/j.psychres.2020.113172.
28. Lee DS, Mirmirani P, McCleskey PE, Mehrpouya M, Gorouhi F. Cutaneous manifestations of COVID-19: a systematic review and analysis of individual patient-level data. Dermatol Online J. 2020; 26(12): doi: 13030/qt7s34p8rw.
29. Logue JK, Franko NM, McCulloch DJ, et al. Sequelae in adults at 6 Months after COVID-19 infection. JAMA Netw. 2021; 4(2):e210830. doi:10.1001/jamanetworkopen.
30. Mackenzie E, Hannum V, Ramirez , A, et al , Objective sensory testing methods reveal a higher prevalence of olfactory loss in COVID-19-positive patients compared to subjective methods: A systematic review and meta-analysis. Chem Senses2020; 45(9):865-874.
doi: 10.1093/chemse/bjaa064.
31. Mak PQ, Chung KS, Wong JS, Shek CC, Kwan MY. Anosmia and ageusia: not an uncommon presentation of Covid-19 infection in children and adolescents. J. Pediatr Infect Dis J 2020; doi:10.1097/INF.0000000000002718.
32. Mannheim J, Gretsch S, Layden JE, Fricchione MJ. Characteristics of hospitalized pediatric COVID-19 cases - Chicago, Illinois, March - April 2020. J. Pediatric Infect Dis Soc 2020.9 (5):519-522. doi: 10,1093/jpids/piaa070.
33. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: Final data for 2018. National Vital Statistics Reports. Hyatsville, MD: National Center for Health Statistics; 2019.
34. Masokano IB, Li F, Xie S, et al. Comparing Chinese children and adults with RT-PCR positive COVID-19:A systematic review. .J Infect Public Health. 2020; 13(10):1424-1431. doi: 10.1016/j.jiph.2020.06.036.
35. Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcomes of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020. 15; 57(9):820-826. doi: 10.1007/s13312-020-1961-0.
36. Moreira, A. Kawasaki disease linked to COVID-19 in children. Nat. Rev Immunol. 2020. Long-term sequelae following previous coronavirus epidemics. Clinical Medicine, 2021, 21; 68-70.
37. Panahi L, Amiri M, Pouy S. Clinical characteristics of COVID-19 infection in newborns and pediatrics: A systematic review. Arch Acad Emerg Med. 2020 18; 8, 1.
38. Panda PK, Sharawat IK, Panda P, Natarajan V, Bhakat R, Dawman L. Neurological complications of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Pediatr Infect Dis J. 2020; 39(11): doi: 10.1097/INF.0000000000002888.
39. Patanè L, Morotti D, Giunta MR. Vertical transmission of COVID-19: SARS-CoV-2 RNA on the fetal side of the placenta in pregnancies with COVID-19 positive mothers and neonates at birth. Am J Obstetrics Gynecol MFM. 2020. 12: doi 10,1155/2020/8460672.
40. Pierce-Williams RAM, Burd J, Felder L. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstetrics Gynecol MFM. 2020. 2(3):100134. doi:10,1016/j.ajogmf.2020.100134.
41. Pousa PA, Mendonça TSC, Oliveira EA, Simões-SilvaAC.Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations. .J Pediatr (Rio J). 2021; 97(2):116-139.
doi: 10.1016/j.jped.2020.08.007.
42. Qiu C, Cui C, Hautefort C, et al. Olfactory and gustatory dysfunction as an early identifier of COVID-19 in adults and children: An international multicenter study. Otolaryngol Head Neck Surg 2020: doi: 194599820934376.
43. Raba AA, Abobaker A, Elgenaidi IS, Daoud A. Novel coronavirus infection (COVID-19) in children younger than one year: A systematic review of symptoms, management and outcomes. Acta Paediatr. 2020; 109(10):1948-1955. doi: 10.1111/apa.15422.
44. Rathore V, Galhotra A, Pal R, Sahu KK COVID-19 pandemic and children: A review. Pediatr Pharmacol Ther. 2020; 25(7):574-585. doi: 10.5863/1551-6776-25.7.574.
45. Rocke J, Hopkins C, Philpott C, Kumar, N. Is loss of sense of smell a diagnostic marker in COVID-19: A systematic review and meta-analysis. Clin Otolaryngol. 2020; 45(6):914-922. doi: 10.1111/coa.13620. 32741085.
46. Rokkas T. Gastrointestinal involvement in COVID-19: a systematic review and meta-analysis.Ann Gastroenterol. 2020; 33(4):355-365.
doi: 10.20524/aog.2020.0506.
47. Sahu KK, Kumar R. Current perspective on pandemic of COVID-19 in the United States. J. of Family Medicine and Primary Care, 2020, 30:1784-1791.
48. Saurabh K, Ranjan S. Compliance and psychological impact of quarantine in children and Adolescents due to Covid-19 pandemic. Indian J Pediatr. 2020; 87(7):532-536.
doi: 10.1007/s12098-020-03347-3.
49. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020:174 (9): 868-873. doi:10,1001/jamapediatrics2020,1948.
50. Thompson EC, Thomas, SA, Burke, TA et al. Suicidal thoughts and behaviors in psychiatrically hospitalized adolescents pre- and post-COVID: A historical chart review and examination of contextual correlates. Journal of Affective Disorder Reports. 2021. doi:10.1016/j.adr.2021.100100.
51. US Centers for Disease Control and Prevention. Cases in the U.S. Atlanta, GA. 2020.
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/ cases-in-us.html
52. Wang JG, Cui HR, Tang HB, Deng XL. Gastrointestinal symptoms and fecal nucleic acid testing of children with 2019 coronavirus disease: a systematic review and meta-analysis. Sci Rep. 2020: 10(1):17846. doi: 10.1038/s41598-020-74913-0.
53. Wang XF, Yuan J, Zheng YJ, et al. Retracted: Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi. 2020. 17:58 (0). doi: 10.3760.2020.0008.
54. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239–1242.
55. Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID-19 in children: A systematic review.Pediatr Pulmonol. 2020; 55(10):2565-2575. doi: 10.1002/ppul.24991.
56. Yoon SH Kang JM, Ahn JG. Clinical outcomes of 201 neonates born to mothers with COVID-19: a systematic review.Eur Rev Med Pharmacol Sci. 2020; 24(14):78047815.doi:10.26355/eurrev_202007_22285.
57. Yu N, Li W, Kang Q. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020. 20(5):559-564.
doi 10.1016/S1473-3099 (20) 30176-6.
58. Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in China.
59. Yue J, Zang X, Le Y, An Y. Anxiety, depression and PTSD among children and their parents during 2019 novel coronavirus disease (COVID-19) outbreak in China. Curr Psychol.14: 1-8. doi: 10,1007/s12144-020-01191-4.
60. Zhang, C., Huang, L., Tang, X, Zhang, Y, & Zhou, X. Pulmonary sequelae of pediatric patients after discharge for COVID-19: An observational study. Pediatric Pulmonology 2020; 1-4 doi:org/10.1002/ppul.25239.
61. Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis J. 2020; 39(6):469-477. doi: 10.1097/INF.0000000000002700.PMID: 32398569.