ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

1 - Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Unidade de Infecciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Unidade de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa

- Comunicação oral na reunião internacional “13th Excellence in Pediatrics Conference”

Resumo:
Background: Until august 2021, 144015 children and adolescents under 18 years old were diagnosed with SARS-CoV-2 infection in Portugal. Although COVID-19 is usually mild in this population, children may be severely affected. Cardiac involvement may result from direct viral myocardial injury, ischemia and exaggerated inflammatory response.
Methods: Case series including all children admitted with COVID-19 to a tertiary paediatric hospital from march/2020 to august/2021. We analysed socio-demographic data and looked for myocardial dysfunction biomarkers (troponin and NT-proBNP > 2 times the normal range), electrocardiogram (ECG) and/or cardiac imaging findings (echocardiogram and magnetic resonance image (MRI)).
Results: Of a total of 395 patients admitted with SARS-CoV-2 infection, 171 children had COVID-19. The remaining 224 were admitted due to other conditions with detected SARS-CoV-2 by RT-PCR. The median age of the COVID-19 group was 3.9 years (P25-P75 0.7-10.0) and 104 patients (61%) were male. Main diagnosis included: COVID-19 pneumonia (84), MIS-C (59), COVID-19 (11), small infant sepsis (6), sepsis (4), encephalitis/meningitis (4), myocarditis (1), acute hepatic injury (1) and myositis (1). 63/171 (37%) showed evidence of cardiac involvement. Biomarkers of cardiac injury were elevated in 76/171 (44%) and 63/171 (37%) had values 2 times higher than the normal range: NT-proBNP (37), both troponin and NT-proBNP (26). Alterations in the ECG were found in 17/171 (10%); 12 of whom presented with biomarker elevation. The ECG abnormalities were: sinusal tachycardia (6), unspecified repolarization alterations (2), PR prolongation (2), PR depression (1), atrioventricular block (1), T wave inversion (1), left ventricular (LV) hypertrophy (1), low-voltage QRS (1), sinusal bradycardia (1) and ST depression (1). Echocardiographic alterations appeared in 24/171 cases (14%): mitral regurgitation (11), pericardial effusion (6), tricuspid regurgitation (4), reduced ejection fraction (3), coronary dilatation (2), LV dilatation (1), atrioventricular valvulitis (2), LV hypertrophy (2), interventricular septum dyskinesia (2). Cardiac MRI 6 months after discharge was performed in 10 patients, showing alterations in 5 individuals: subepicardial necrotic scarring of the LV inferior wall (3), interventricular septum fibrosis (1), and coronary dilation (1).
Conclusions: Although rare, cardiovascular involvement in children with COVID-19 can be severe. In our cohort, it was present in more than one third of the cases. Multidisciplinary workup is essential to manage these patients. Long-term consequences of paediatric severe COVID-19 remain uncertain, reinforcing the importance of long-term follow-up.

Palavras Chave: Cardiac injury, COVID-19, paediatric