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New findings on 2 ways children get seriously ill with coronavirus

A large national study has found significant differences in the two main ways children are critically ill from the coronavirus, findings that may help doctors and parents better recognize the conditions and better understand children at risk for each .

The study, published Wednesday in the journal JAMA, analyzed 1,116 cases of young people treated in 66 hospitals in 31 states. Just over half of the patients had acute Covid-19, the predominantly lung disease that afflicts most adults who become ill with the virus, while 539 patients had the inflammatory syndrome which flared in some children weeks after having had an initial infection.

The researchers found similarities, but also significant differences in the symptoms and characteristics of patients, who ranged from infants to 20-year-olds and were hospitalized last year between March 15 and October 31.

Young people with the syndrome, called pediatric multisystem inflammatory syndrome or MIS-C, were more likely to be between the ages of 6 and 12, while over 80% of patients with acute Covid-19 were under the age of 6 or more. than 12.

More than two-thirds of patients with either condition were black or Hispanic, which experts say likely reflects socio-economic and other factors that have disproportionately exposed some communities to the virus.

“It is still shocking that the overwhelming majority of patients are not white and this is true for MIS-C and for acute Covid,” said Dr Jean A. Ballweg, medical director of pediatric heart transplantation and advanced heart failure at Children’s Hospital & Medical Center in Omaha, which did not participate in the study. “There is clearly a racial disparity there.”

For reasons that are unclear, while Hispanic youth seemed just as likely to be at risk for both conditions, black children appeared to be at greater risk of developing inflammatory syndrome than acute illness, Dr. Adrienne Randolph, lead author of the study and pediatric critical care specialist at Boston Children’s Hospital.

One potential clue the authors mentioned is that with Kawasaki disease, a rare childhood inflammatory syndrome that has similarities to some aspects of MIS-C, black children appear to have a higher frequency of heart abnormalities and are less responsive. to one of the standard treatments: intravenous immunoglobulin.

Researchers found that young people with inflammatory syndrome were much more likely to have had no underlying medical conditions than those with acute Covid. Yet more than a third of patients with acute Covid had no previous medical problem. “It’s not like previously healthy kids are completely scotch-free here,” Dr Randolph said.

The study assessed obesity separately from other underlying health conditions and only in patients aged 2 years or older, finding that a slightly higher percentage of young people with acute Covid suffered from obesity.

Dr Srinivas Murthy, associate professor of pediatrics at the University of British Columbia, who was not involved in the study, said he was not convinced the results established healthy children were at higher risk of MIS-C. This could be “mostly a numbers game, with the proportion of infected children and the proportion of healthy children, rather than saying that there is something immune in healthy children that puts them at risk. at a disproportionately higher risk, ”he said.

Overall, he said, the study’s documentation of the differences between the two conditions was helpful, especially because it reflected “a reasonably representative set of hospitals across the United States.” .

Young people with inflammatory syndrome were more likely to need treatment in intensive care units. Their symptoms were much more likely to include gastrointestinal issues and inflammation and to involve the skin and mucous membranes. They were also much more likely to have heart problems, although many patients with acute Covid did not receive detailed heart assessments, the study noted.

About the same large proportion of patients with each condition – more than half – required respiratory support, with just under a third of those requiring mechanical ventilation. Roughly the same small number of patients in each group died: 10 with MIS-C and eight with acute Covid-19.

The data does not reflect a recent increase in inflammatory syndrome cases that followed an increase in overall Covid-19 infections across the country during the winter holiday season. Some hospitals have reported that there were a greater number of critically ill MIS-C patients in the current wave compared to previous waves.

“I’m going to be fascinated to see the comparison between November 1 and this group because I think we all felt that children with MIS-C have been even sicker recently,” Dr Ballweg said.

An optimistic sign from the study was that most serious heart problems in young people with inflammatory syndrome improved to normal within 30 days. Still, Dr Randolph said the residual effects were still unknown, which is why one of his co-authors, Dr Jane Newburger, associate head of academic affairs in the Department of Cardiology at Boston Children’s Hospital, is conducting a study. national program to follow children with inflammatory syndrome for up to five years.

“We can’t say for 100% for sure that everything is going to be normal in the long term,” Dr Randolph said.

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