Cardiovascular complications following COVID-19 are rare in children and young adults

Cardiac complications in children with COVID-19 are rare, but case reports have noted cardiogenic shock, myocarditis, pericarditis, and arrhythmias.

A new scientific statement has called for more research into the treatment and management of cardiovascular complications of COVID-19 in children and young adults, although they are relatively rare in these age groups.

According to the researchers, some pediatric and adolescent patients with COVID-19 may experience abnormal heart rhythm, inflammation in and around the heart muscle, or multisystem inflammatory syndrome in children (MIS-C), which is a new condition identified during the pandemic. COVID-19 vaccines have been found to prevent severe COVID-19 disease and reduce the risk of developing MIS-C by 91% in children aged 12 to 18, but more research is still needed, according to the investigators.

“Two years into the pandemic and with vast amounts of research being conducted on children with COVID-19, this statement summarizes what we know so far regarding COVID-19 in children,” Pei- Ni Jone, MD, FAHA, chair of the Statement Writing Group, in a press release. “We focused on the effects of this virus for people with congenital or other heart conditions, as well as the latest data on the potential association of COVID-19 vaccines with heart complications in children and young adults. Although we know a lot, this public health emergency requires continued research to understand the short- and long-term impacts on children.

Analysis of the latest research suggests that children generally show mild symptoms of SARS-CoV-2 infection, according to the scientific statement. In the United States, as of February 24, 2022, children accounted for 17.6% of total COVID-19 cases and approximately 0.1% of deaths from the virus. Additionally, young adults between the ages of 18 and 29 accounted for 21.3% of cases and 0.8% of deaths from COVID-19.

Several factors may help explain why children may be less susceptible to severe COVID-19 infection. For example, children’s body cells have fewer receptors to attach to the SARS-CoV-2 virus, and children may also have a weaker immune response due to a different cytokine response compared to adults and trained immunity to other vaccines and viral infections.

Although children with congenital heart disease had low rates of infection and mortality from SARS-CoV-2, the researchers noted that having an underlying genetic syndrome, such as trisomy 21 ( also known as Down syndrome), appears to be associated with an increased risk of severe COVID-19.

The statement also outlines available treatments for children with COVID-19, although there are currently no specific antiviral therapies for COVID-19. Available treatments include remdesivir and dexamethasone for children in certain age groups.

Remdesivir is the only antiviral currently approved by the FDA for the treatment of people ages 12 and older hospitalized with COVID-19 who have risk factors for severe disease and need supplemental oxygen. Notably, it is most effective when given as soon as possible after the onset of symptoms. Dexamethasone has been shown to reduce the risk of death in adults with COVID-19 and is suggested for children with more severe disease who require respiratory support.

Cardiac complications in children with COVID-19 are rare, but case reports have noted cardiogenic shock, myocarditis, pericarditis, and arrhythmias. Sudden cardiac death and death following intensive medical treatment and life-sustaining therapy have occurred in children with severe COVID-19 that has affected the heart.

Myocarditis is most commonly caused in children by a viral infection, with about 1 to 2 in 100,000 children diagnosed with myocarditis each year in the United States before the COVID-19 pandemic, according to CDC data. Children are also more likely than adults to develop myocarditis following a viral infection, such as COVID-19.

MIS-C was identified early in the pandemic, with up to half of global pediatric cases involving inflammation of the heart muscle or heart arteries. In the first year of the pandemic, 1 in 3,164 children infected with SARS-CoV-2 developed MIS-C, the statement said.

For children who develop MIS-C, intravenous immunoglobulin (IVIg) has been given alone or in combination with infliximab or other immunomodulating agents. Most children’s hearts recover well within 1-4 weeks of being diagnosed with MIS-C, but the risk of long-term complications and death from MIS-C is estimated to be between 1.4% and 1 .9%.

The majority of MIS-C cases involved children identified in medical records as black or Hispanic. More research is needed to find out why people from various racial or ethnic groups may be disproportionately affected and to understand the risk factors for this disease, according to the authors of the statement.

The researchers also looked specifically at the safety of returning to sport and vigorous physical activity for children and adolescents who have had COVID-19. The latest data suggests that those who have had a mild COVID-19 infection or an infection without symptoms can safely return to activities after symptoms have fully recovered.

For young people with a more serious infection or who develop MIS-C, the statement says it is reasonable to consider certain cardiovascular screenings, such as an echocardiogram, blood tests for heart enzyme levels and other heart function screening tests before returning to sport.

The scientific statement concluded that more research is needed to better understand the mechanisms and optimal treatment approaches for SARS-CoV-2 infection, vaccine-associated myocarditis, long-term outcomes of COVID-19 and of MIS-C, and the impact of these various conditions on the heart in children and young adults. Additionally, the researchers said the development of new antiviral therapies needs to be tested in clinical trials focused on pediatric patients.

“While much has been learned about the impact of the virus on the hearts of children and young adults, the best way to treat cardiovascular complications and prevent serious illness and further clinical research trials are needed to better understand the long-term cardiovascular impacts,” Jone said in the press release. “It is also important to address health disparities that have become more apparent during the pandemic. We must work to ensure that all children have equal access to immunization and high-quality care.

REFERENCE

Heart problems after COVID-19 rare in children and young adults, more research needed. Press release. American Heart Association; April 11, 2022. Accessed April 18, 2022. https://newsroom.heart.org/news/heart-issues-after-covid-19-uncommon-in-children-young-adults-more-research-needed?preview=528c

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