Medical Technology

GI Symptoms in Kids With COVID May Predict Severe Outcomes

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The presence of severe digestive (GI) involvement is common in children who have had COVID-19, a new study suggests.

Andrea Lo Veccio MD, PhD, of the Department of Translational Medical Sciences Section of Pediatrics at University of Naples Federico II in Naples, Italy and his colleagues retrospectively analysed data from a large cohort of 18-year-old children who were diagnosed with COVID-19 in 54 Italian institutions between February 25 between 2020 until January 20, 2021.

The study included 685 kids from Italy (56.4% of whom were boys; median age 7 years). Of these 628 (91.7 percent) were diagnosed with acute SARS-CoV-2 infection , and 57 (8.3%) with multisystem inflammatory syndrome in children (MIS-C).

The researchers found that children who had GI symptoms had a higher risk of being admitted to hospital (odds ratio [OR2.64, 2.64, 95% CI. 1.89 – 3.69) as well as nearly four times the likelihood of admission to an intensive care unit (ICU). OR, 3.90, 95% 95% CI. 1.98 – 7.68.

65 children showed severe GI involvement (9.5 9 %). The authors included the following within the category: disseminated Adenomesenteritis (39.6%), appendicitis (33.5%) abdominal fluid collection (21.3 percent) pancreatitis (6.9 percent), or intussusception (4.6 percent). Also, 27 out of 65 children (41.5%) were treated with surgery.

Older children were significantly more likely than preschoolers to suffer from severe GI symptoms. Children between the ages of 5 and 10 were eight times more likely to have severe symptoms than those between the ages of 6 and 10 years old. The severity of symptoms was six times more prevalent for those who were over 10 years of age (6.37; 95% CI, 2.12- 19.1).

Awareness about its frequency and presentation may help practitioners to appropriately manage children who are at risk of having serious outcomes, the authors write.

The findings of this study were published online on December 20 in JAMA Network Open.

Study Highlights the GI Link

William Balistreri, MD, Division of Gastroenterology, Hepatology and Nutrition at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, was contacted for comment. He explained that it is common knowledge that children are more likely to suffer from GI symptoms than adults and that these symptoms are particularly common in children suffering from MIS.

Dr William Balistreri

“The symptoms most often cited in the literature to date include diarrhea, nausea, vomiting or abdominal pain,” he said. “What is not known is the course of clinical manifestations and frequency of severe GI manifestations of COVID-19.

Clinicians can utilize the results of this study to detect severe GI involvement. Balistreri noted that abdominal pain, leukopenia, and an elevated inflammatory marker such as MIS-C could indicate a problem, which should lead to early evaluation.

Margaret E. Thew (APNP) Medical director of adolescent medicine and a family nurse practitioner at Medical College of Wisconsin in Milwaukee also contributed. She noted that, while news reports tend to focus on respiratory involvement the study provides an in-depth analysis of how COVID-19 may be related to GI symptoms.

Margaret E. Thew (APNP).

She said that her data revealed that children could suffer less from respiratory illnesses regardless of their general health. “They may be more prone to GI symptoms.

“We know that COVID-19 causes a lot of inflammation, and a large percentage of these kids had inflammation in their stomach or an inflamed bowel.” She added.

Thew said that primary care doctors as well as urgent and emergency care healthcare professionals will benefit from the findings of this study and should be alert when kids come in with stomach discomfort or vomiting.

She said that parents can also benefit if they wait for a respiratory infection to suspect COVID.

She said that “you have to have the highest probability that this will be positive for COVID.” “You have to have this as part of your thinking process.”

Thew stated that, despite the fact that the study was conducted in Italy, their experiences were similar to those she had observed locally.

Lo Vecchio reports fees paid by Pfizer for being an advisory board member. Co-authors report speaker’s fees from Angelini, Sobi, and X4 Pharma outside the submitted work. Other disclosures were not reported. Thew and Balistreri report no relevant financial relations.

JAMA Netw Open. Published online December 20 and 2021. Full text

Marcia Frellick is a freelance journalist who is based in Chicago. Follow her on Twitter at @mfrellick.

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