Children infected with COVID-19 show severe Gastrointestinal symptoms: JAMA

Severe gastrointestinal (GI) symptoms in children with COVID-19 have been documented occasionally; nevertheless, their prevalence and clinical prognosis are unclear.

According to a new study done by Andrea Lo Vecchio and colleagues, 9.5% of Italian infants with SARS-CoV-2 infection or MIS-C exhibited significant GI involvement, which is usually linked with MIS-C.

The findings of this study were published in the Journal of American Medical Association on 20th December, 2021.

The objective of this study was to discover parameters linked with a severe prognosis, the clinical, radiological, and histopathologic features of children with COVID-19 presenting with severe GI symptoms were described.

This was a multicenter retrospective cohort study that enrolled inpatient and outpatient children within 18 years of age, with acute SARS-CoV-2 infection, confirmed by positive real-time reverse-transcriptase–polymerase chain reaction on nasopharyngeal swab or meeting the US Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children (February 25, 2020 to January 20, 2021). (MIS-C).

The investigation was carried out by doctors working in primary care or hospitals in Italy who were members of the Italian Society of Pediatric Infectious Diseases' COVID-19 Registry. The primary outcome was the occurrence of severe GI manifestations, defined as acute abdomen, appendicitis, intussusception, pancreatitis, abdominal fluid collection, and diffuse adeno-mesenteritis requiring surgical consultation, occurring during or within 4 to 6 weeks of SARS-CoV-2 infection. The odds ratios (ORs) with 95 percent confidence intervals (CIs) of covariates possibly linked with severe outcomes were estimated using logistic regression.

The key findings are:

1. There were 685 children in total (386 boys [56.4%]; median age, 7.3 [IQR, 1.6-12.4] years).

2. Six hundred and twenty of these youngsters (91.7%) were diagnosed with acute SARS-CoV-2 infection and 57 (8.3%) with MIS-C.

3. The presence of GI symptoms was linked to an increased risk of hospitalization and critical care unit admission. Overall, 65 children (9.5%) had severe GI involvement, including diffuse adeno mesenteritis (39.6%), appendicitis (33.5%), abdominal fluid collection (21.3%), pancreatitis (6.9%), or intussusception (4.6 percent ).

4. Twenty-seven (41.5%) of the 65 children had surgery. Severe gastrointestinal signs were linked to the child's age, abdominal discomfort, lymphopenia, or MIS-C.

5. Diarrhea was linked to an increased risk of adeno mesenteritis or abdominal fluid accumulation.

In conclusion, Awareness of the risk factors for severe GI manifestations may aid practitioners working in emergency departments or primary care settings in identifying children with these illnesses and managing children at risk for catastrophic outcomes. In school-aged children and adolescents, as well as any children presenting with abdominal discomfort, leukopenia, raised inflammatory markers, or MIS-C, a high level of suspicion should be maintained, since these children may require immediate abdominal imaging and surgical consultation.

Reference:

Lo Vecchio A, Garazzino S, Smarrazzo A, et al. Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome. JAMA Netw Open. 2021;4(12):e2139974. doi:10.1001/jamanetworkopen.2021.39974