Nemours reports on COVID-19 in children

Three teenagers were identified in Delaware as having an inflammatory syndrome that may be linked to COVID-19.

The teenagers were admitted to Nemours. Two have been discharged, said Dr. Shubhika Srivastava, chief of cardiology at the hospital. The third is improving, she said.

The teens are among a small, but growing, amount of children and adolescents in the country who are experiencing pediatric multisystem inflammatory syndrome thought to be linked to coronavirus.

“They represent very differently from adults, where they present with high fevers, but more abdominal symptoms, diarrhea, vomiting, rash, loss of appetite, listlessness,” she said. “And then loss in blood pressure and respiratory symptoms come later.”

Dr. Srivastava said that from the initial data and reports that came from Wuhan, “there were very few children who were affected of all age groups.” A majority of those children had the same symptoms as adults, with respiratory illness.

Last month, however, Nemours had a patient who had symptoms that weren’t classic to COVID-19, she said, with lack of appetite, fever, abdominal pain and rashes. His health began to decline and cardiology became involved, she said.

“We treated him like we would treat any child who would have a significant inflammatory response involving multiple organ systems,” she said. “He actually responded really, really well.”

Nationally, she said, it seems that all cases were not coronavirus positive, “but all are antibody positive, suggesting evidence of exposure,” she said.

She added that the first patient at Nemours tested negative for coronavirus, but in a follow up visit, his antibodies suggested that he had been exposed to COVID-19. The other two cases have been COVID-19 positive.

“Just based on our experience and learning — like now that lots of states are reporting such cases — it seems that it’s very different from the way it is presenting in the adult population,” she said.

The symptoms, however, are familiar to medical professionals: they appear similar to Kawasaki syndrome and toxic shock syndrome.

“The age group in which this is presenting is not the same age group that those diseases would present,” she said. “The reason it currently has raised an alarm is because it’s new, it’s affecting young children of all ages, but the majority of the children are teenagers.”

“But the good part is they’re responding to therapy, and a majority of the cases are surviving,” she added.

Patients are being treated with immunoglobulin and steroids.

She added that they are now looking back and investigating other cases, to see if it could have been a manifestation of the syndrome before they were aware of it.

“We are in the process of that right now, evaluating them, and will have more data as time goes on,” she said.

For the three patients, she said that abdominal pains and fever were consistent. One did show respiratory symptoms. Looking at national data, abdominal symptoms, rash and loss of appetite have been prevalent.

Recovery has been about a week to 10 days, she added.

When it comes to protecting adolescents and teenagers, Dr. Srivastava said parents should continue to maintain social distancing, hand washing and mask-wearing practices.

“They shouldn’t get the message that as the state is reopening, and even though people are returning back to some normal activity, that means that COVID has gone away,” she said. “So people should continue to take the same precautions.”

And if the parents are seeing the development of any symptoms — in any order, and as a “constellation of symptoms,” they should seek medical help.

“It is very safe at Nemours for people to bring the children in for care because the appropriate measures or protection of the personnel are already in place,” she said. “So I think people fear to bring the children because they are scared, they don’t want to go to the hospital and get exposed to COVID, but, in such cases, they should make the decision to come in, so the child can get timely care. The care should not be delayed.”

She said that Nemours is taking a multidisciplinary approach and has created a group that represents all specialties, from infectious disease, to rheumatology, to intensive care, to cardiology, to gastroenterology.

Meanwhile, they’re also joining calls from centers around the world to discuss and learn more, she said.

“What’s really important is all the physicians come together to take care of such patients in a multidisciplinary approach,” she said.

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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