Comprehensive Clinic, Laboratory and Instrumental Evaluation of Children with COVID-19: A 6-Months Prospective Study
J Med Virol. 2021 Feb 11. doi: 10.1002/jmv.26871.
Sara Isoldi 1 2, Saverio Mallardo 1, Alessia Marcellino 1, Silvia Bloise 1, Anna Dilillo 1, Donatella Iorfida 1, Alessia Testa 1, Emanuela Del Giudice 1, Vanessa Martucci 1, Mariateresa Sanseviero 1, Antonio Barberi 1, Massimo Raponi 1, Flavia Ventriglia 1, Riccardo Lubrano 1
Objectives: To perform a comprehensive clinic, laboratory and instrumental evaluation of children affected by COVID-19.
Methods: Children with a positive result of nasopharyngeal swab for SARS-CoV-2 underwent laboratory tests, anal and conjunctival swab, electrocardiography, lung, abdomen and cardiac ultrasound. 24-h ambulatory blood pressure monitoring was performed if abnormal basal blood pressure. Patients were followed-up for 6 months.
Results: 316 children were evaluated; 15 were finally included. Confirmed family member SARS-CoV-2 infection was present in all. 27% were asymptomatic. Anal and conjunctival swabs tests resulted negative in all. Patients with lower BMI presented significantly higher viral loads.
Main laboratory abnormalities were:
- LDH increasing (73%),
- low vitamin D levels (87%)
- hematuria (33%),
- proteinuria (26%),
- renal hyperfiltration (33%) and
- hypofiltration (13%).
Two of the patients with hyperfiltration exhibited high blood pressure levels at diagnosis, and persistence of a prehypertension at 6-month follow-up. No abnormalities were seen at ultrasound, excepting for one patient who exhibited B-lines at lung sonography. IgG seroconversion was observed in all at 1-month.
Conclusions: Our study confirm that intra-family transmission is important. The significant higher viral loads recorded among patients with lower BMI, together with low vitamin D levels, support the impact of nutritional status on immune system. Renal involvement is frequent even among children with mild COVID-19, therefore prompt evaluation and identification of patients with reduced renal function reserve would allow a better stratification and management of patients. Seroconversion occurs also in asymptomatic children, with no differences in antibodies titer according to age, sex and clinical manifestations.
Virus and infant-child studies are listed here:
- 87 percent of children with COVID–19 had low vitamin D (small study) – Feb 2021
- 13 possible reasons why COVID-19 is less severe in children – Dec 1, 2020
- Vitamin D associated with reduced COVID-19 risks in children - GRH Nov 2020
- Children with low vitamin D far more likely to hospitalized with COVID-19 – Oct 2020
- Respiratory viral infection (RSV) and low vitamin D – July 2020
- Increased weight in children 8X more likely for each unit increase in adenovirus (if ignore Vitamin D) – Nov 2019
- Severe hand, foot, and mouth virus is 2.9 X more likely if poor Vitamin D receptor – Oct 2018
- More US infants die in 1st day than in all other developed countries COMBINED (and US gives vaccine in first day) – May 2013
- Hand, Foot, and Mouth disease (virus) strongly associated with low vitamin D – May 2017
- Half the risk of Influenza -A in infants taking 1200 IU of vitamin D for 4 months – RCT Jan 2018
- Child is 2 X more likely to get influenza if have older sibling (perhaps closely-spaced birth) – Sept 2017