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RIO – At a time when classes are resuming, Brazilian pediatricians warn about the symptoms of childhood Covid-19 that parents should know. And they are not just respiratory, as you imagine, and early detection is essential to prevent them from getting worse. Fever and gastrointestinal problems, such as abdominal pain, vomiting and diarrhea, can be a sign of the severe form of childhood Covid-19, underlines Arnaldo Prata Barbosa, pediatric research coordinator at the D’Or Institute for Research and Education (Idor) .
Covid-19 rarely worsens in children and adolescents, and most are asymptomatic. They represent less than 2% of symptomatic Covid-19 cases. However, when they become ill, they can be affected by the so-called pediatric multisystem inflammatory syndrome, better known by the acronym in English MIS.
– The message is that parents should be aware not only of respiratory symptoms. In MIS, gastrointestinal symptoms are more common. A child with fever and abdominal pain should be evaluated for MIS, to have their heart examined, Barbosa emphasizes.
He coordinated the first national survey to describe the characteristics and clinical evolution of children with Covid-19 hospitalized in the ICU in Brazil. The study was carried out by researchers from Idor and 13 other Brazilian institutions, such as Uerj, UFRJ, PUC-RS, Rede D’Or hospitals, Hospital Sírio Libanês (SP), among others.
The scientists analyzed cases of 79 children and adolescents, from 1 month to 19 years old, admitted to 19 pediatric ICUs (seven from public hospitals and 12 private) associated with the Brazilian Network for Pediatric Intensive Care Research in the states of Rio de Janeiro. Janeiro, São Paulo. , Bahia, Ceará and Pará.
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MIS affects several organs, including the heart, kidneys, liver, intestine, brain, skin, and spleen. It mainly affects the heart. Microthrombi are common. It is a condition that can cause death or leave sequelae.
MIS is so different from the characteristic characteristic of severe Covid-19, in which there is significant lung involvement, that some doctors prefer to call the latter “classic Covid-19”, although both forms have been known for less than ten months . MIS accounts for approximately 20% of severe Covid-19 cases in children.
In addition to drawing attention to the signs of MIS, the study challenges two aspects of childhood Covid-19 highlighted by international research.
The first is that babies younger than 1 year are at higher risk of getting worse. Under the title “Pediatric patients with Covid-19 admitted to Intensive Care Units in Brazil: a prospective multicenter study,” the research showed that infants do not have a greater need for mechanical ventilation (intubation) than older children.
The second is that children have different risk factors for complications than those associated with worsening Covid-19 in adults. The previous diseases or comorbidities are different, says Barbosa.
While in adults cardiovascular diseases and diabetes are important, in children the main comorbidities observed in Brazil, according to the study, have been neuromuscular (especially non-progressive encephalopathy) and chronic respiratory diseases, mainly asthma.
According to the study, the probability that a child with some comorbidity will develop a severe form of Covid-19 is 5.5 times higher compared to children without comorbidity. Of the 79 patients analyzed, 41% had comorbidities. Barbosa recommends dual care for parents of children with comorbidities.
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The respiratory form of Covid-19 is the most frequent. It begins with predominantly respiratory symptoms and reaches the lungs, but not only them. Most of these children test positive on a molecular test (RT-PCR) for coronavirus, an indicator of an acute infection.
MIS is a mystery. The child can arrive at the hospital without previous symptoms and test negative in RT-PCR. However, antibody (serology) tests almost always reveal that you were exposed to the coronavirus. And in those who had symptoms of infection, these almost always manifested two to four weeks before the worsening.
Parents are not always able to identify the symptoms because they are very mild and go unnoticed, says the pediatrician.
Uncertainty about the sequel
MIS can be very serious, causing heart failure and even shock, says Barbosa. And doctors acknowledge that it is not yet known how coronavirus infection leads to MIS and what makes a child vulnerable. In the Brazilian study, the scientists observed that it generally affects older children and 80% of the cases were children.
Pediatricians say it will be necessary to monitor children who have contracted MIS for sequelae.
– MIS is a new phenomenon related to children’s Covid-19. But children have a greater capacity for recovery. Only time will tell us if there will be long-term consequences or not, says the pediatrician.
