COVID-19 and congenital heart disease:a case series of nine children

Background Coronavirus disease 2019(COVID-19)is the current pandemic disease without any vaccine or efficient treat-ment to rescue the patients.Underlying diseases predispose the patients to a more severe disease and to a higher mortality rate.However,little evidence exists about COVID-19 outcomes in the pediatric population with congenital heart disease(CHD).Here,we report nine children with COVID-19 and concomitant CHD.Methods Our study included nine children with COVID-19 and concomitant CHD who were admitted to Children Medical Center Hospital during March and April 2020.The patients were classified based on the final outcome(death),and their clinical sign and symptoms,type of CHD,and drugs administered were compared.Results Among the nine patients,two died and we compared different characteristics,laboratory results and clinical findings of these cases based on the mortality.The deceased patients had severe types of CHD,worse arterial blood gases,severe clinical symptoms,higher mean level of partial thromboplastin time and C-reactive protein,and required more medications.Conclusions The present study showed that the general consideration of mild COVID-19 in children does not include patients with CHD and that it is necessary to pay greater attention to children with CHD to determine guidelines for treatment of COVID-19 in these children.Owing to the scarcity of CHD and COVID-19,we reported only nine cases.However,further studies are highly required in this regard.

Gastrointestinal viral shedding in children with SARS‑CoV‑2:a systematic review and meta‑analysis

Background Coronavirus disease 2019(COVID-19)has diferent manifestations in pediatric cases.It is assumed that they might present more gastrointestinal symptoms with a diferent viral shedding pattern in gastrointestinal samples.In this systematic review and meta-analysis,we aimed to evaluate the viral shedding pattern in gastrointestinal specimens of children with COVID-19.Methods We searched all published studies in English language in PubMed,Web of Science,and Scopus,up to date as of October 2021.Our search included the term"severe acute respiratory syndrome coronavirus 2,COVID-19,SARS-CoV-2,novel coronavirus,or coronavirus;and shed,excrete,secret,or carriage;and stool or rectal;and children or pediatrics".We included studies evaluating SARS-CoV-2 shedding in gastrointestinal specimens,including rectal swabs and stool samples of children with COVID-19 infection.We excluded duplicated data,case reports,and studies without original data.Results Twelve studies met the eligibility criteria for the qualitative synthesis,10 of which were included in the meta-analysis.The pooled prevalence of gastrointestinal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA in children with COVID-19 was 86%(95%confdence interval 73%–96%,I 2=62.28%).After respiratory specimen had become negative,72%(43/60)had persistent shedding in gastrointestinal specimens.The gastrointestinal RNA had a positive test result for more than 70 days after symptoms onset.Conclusions Gastrointestinal shedding of SARS-CoV-2 might occur in a substantial portion of children and might persist long after negative respiratory testing.Further research is recommended to fnd the role of SARS-CoV-2 gastrointestinal shedding in transmission in children.