Pediatric Annals

Editorial Free

What Are the Newest Effects of COVID-19 in Children?

Joseph R. Hageman, MD

Although I have reviewed important aspects of COVID-19 in the pediatric and adolescent age groups in two previous editorials,1,2 new information is published daily. There is more clinical information that has been reported regarding a pediatric immune multisystem syndrome that resembles Kawasaki disease or toxic shock syndrome, which the Centers for Disease Control and Prevention has called multisystem inflammatory syndrome in children (MIS-C)3–8,9,10 Children have presented with persistent fever and a variety of clinical manifestations, which may involve multiple organ systems and elevated proinflammatory markers. MIS-C may present weeks after a mild or even clinically asymptomatic infection.9,10 Second, a variety of cutaneous manifestations have been reported, most commonly in adults but also in pediatric patients.11–14 A registry has been set up by the American Academy of Dermatology for clinicians to report these skin findings.9 Third, there is also a report of the clinical manifestations and outcomes of a convenience sample of patients admitted to pediatric intensive care units (PICU) in the United States and Canada.15 There were 48 patients admitted to the PICU, with a median age of 13 years13 with COVID-19 diagnosis confirmed with nasal swab polymerase chain reaction. A total of 40 (85%) had preexisting underlying medical conditions including medical complexity, immune suppression/malignancy, and obesity.13 This group of patients presented with respiratory symptoms most frequently, and 39 required respiratory support above their baseline and 21 were managed noninvasively.13 Targeted antiviral therapies were used in 28 (61%) of patients. Two patients died, both of whom had preexisting medical comorbidities and developed multisystem organ failure.15 At the time of this editorial, 15 children (31%) were still hospitalized including 5 of whom were still critically ill.15 Fourth, an article by Wu et al.16 summarizes the characteristics of 74 pediatric patients with COVID-19, which included (1) abnormalities in leukocyte count in 23 (31%) patients, (2) abnormal lymphocyte count in 10 (13.5%) patients, (3) co-infection with common respiratory pathogens in 19 patients (51%), and (4) prolonged fecal shedding in 10 patients (13.5%). Fifth, what about COVID-19 and postinfection immunity? The limited available data on antibody responses to COVID-19 and one small animal study, “suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily.”17

What is clear is that the clinical spectrum of COVID-19 continues to evolve, and investigators continue to update the literature as quickly as possible. This information will help clinicians provide optimal care for our pediatric patients.


  1. Hageman JR. The coronavirus disease 2019 (COVID-19). Pediatr Ann. 2020;49(3):e99–e100.
  2. Hageman JR. The evolving COVID-19 pandemic: an update. Pediatr Ann. 2020;49(5):e201–e203.
  3. Meissner HC. Ask the expert: What are the presenting signs and symptoms in children with confirmed COVID-19 disease?AAP News. Accessed May 21, 2020.
  4. Jones VG, Mills M, Suarez D, et al. COVID-19 and Kawasaki disease: novel virus and novel case [published online ahead of print April 7, 2020]. Hosp Pediatr. doi:10.1542/hpeds.2020-0123 [CrossRef] PMID:32265235
  5. Healthy Children. COVID-19 and multi-system inflammatory syndrome in children. Accessed May 20, 2020.
  6. Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock syndrome in children during the COVID-19 pandemic [published online ahead of print May 7, 2020]. Lancet. doi:10.1016/S0140-6736(20)31094-1 [CrossRef]
  7. Salcedo A, Cramer M, Gold M, et al. About 100 N.Y. children treated for illness tied to virus. The New York Times. Accessed May 20, 2020
  8. Bernstein L, Cha AE. Doctors keep discovering new ways the coronavirus attacks the body. The Washington Post. Accessed May 20, 2020.
  9. Centers for Disease Control and Prevention. Information for pediatric healthcare providers. Accessed May 21, 2020.
  10. AAP News. Experts shed more light on COVID-19-related inflammatory syndrome in children. Accessed May 21, 2020.
  11. Freeman EE, McMahon DE, Fitzgerald ME, et al. The AAD COVID-19 registry: crowdsourcing dermatology in the age of COVID-19 [published online ahead of print April 16, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.04.045 [CrossRef] PMID:32305438
  12. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective [published online ahead of print March 26, 2020]. J Eur Acad Dermatol Venereol. doi:10.1111/JDV.16387 [CrossRef].
  13. Sachdeva M, Gianotti R, Shah M, et al. Cutaneous manifestations of COVID-19: report of three cases and a review of literature [published online ahead of print April 29, 2020]. J Dermatol Sci. doi:10.1016/j.jdermsci.2020.04.011 [CrossRef] PMID:32381430
  14. Locatelli AG, Test ER, Vezzoli P, et al. Histologic features of long lasting chilblain-like lesions in a pediatric COVID-19 patient [published online ahead of print May 9, 2020]. J Eur Acad Dermatol Venereol. doi:10.1111./JDV.16617 [CrossRef]
  15. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units [published online ahead of print May 11, 2020]. JAMA Pediatr. doi:10.1001/jamapediatrics.2020.1948 [CrossRef] PMID:32392288
  16. Wu Q, Xing Y, Shi L, et al. Co-infection and other clinical characteristics of COVID-19 in children [published online ahead of print May 6, 2020]. Pediatrics. doi:10.1542/peds.2020-0961 [CrossRef]. PMID:32376725
  17. Kirkcaldy RD, King BA, Brooks JT. COVID-19 and postinfection immunity: limited evidence, many remaining questions [published online ahead of print May 11, 2020]. JAMA. doi:10.1001/jama.2020.7869 [CrossRef]. PMID:32391855

Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:


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