Background: Limited pediatric cases with coronavirus disease 2019 (COVID‐19) have been reported and the clinical profiles regarding COVID‐19 in children remain obscure. Our aim was to investigate the clinical characteristics of COVID‐19 in children.Methods: PUBMED and EMBASE were searched through 20 June 2020, for case reports and case series reporting pediatric COVID‐19 cases. Epidemiological, clinical, laboratory, and radiological data were collected and analyzed to compare by age.Results: Our search identified 46 eligible case reports and case series. A total of 114 pediatric cases with COVID‐19 were included. The main clinical features were mild symptoms including fever (64%), cough (35%), and rhinorrhea (16%), or no symptoms (15%). Ground‐like opacities were common radiological findings (54%). The main laboratory findings were lymphopenia (33%) and elevated D‐dimer (52%) and C‐reactive protein (40%) levels. We identified 17 patients (15%) with multisystem inflammatory syndrome in children (MIS‐C) manifesting with symptoms overlapping with, but distinct from, Kawasaki disease, including gastrointestinal symptoms, left ventricular systolic dysfunction, shock, and marked elevated inflammatory biomarkers. Twelve percent of the patients including 65% of the MIS‐C cases required intensive care because of hypotension. No deaths were reported.Conclusion: This systematic review found that children with COVID‐19 are generally less severe or asymptomatic. However, infants might be seriously ill and older children might develop MIS‐C with severe illness. Early detection of children with mild symptoms or an asymptomatic state and early diagnosis of MIS‐C are mandatory for the management of COVID‐19 and the prevention of transmission and a severe inflammatory state.

Background: Multisystem inflammatory syndrome in children (MIS‐C) associated with coronavirus disease 2019 has been increasingly recognized. However, the clinical features of MIS‐C and the differences from Kawasaki disease remain unknown. The study aims to investigate the epidemiology and clinical course of MIS‐C.Methods: PubMed and EMBASE were searched through August 30, 2020. Observational studies describing MIS‐C were included. Data regarding demographic features, clinical symptoms, laboratory, echocardiography and radiology findings, treatments, and outcomes were extracted. Study‐specific estimates were combined using one‐group meta‐analysis in a random‐effects model.Results: A total of 27 studies were identified including 917 MIS‐C patients. The mean age was 9.3 (95% confidence interval [CI], 8.4–10.1). The pooled proportions of Hispanic and Black cases were 34.6% (95% CI, 28.3–40.9) and 31.5% (95% CI, 24.8–38.1), respectively. The common manifestations were gastrointestinal symptoms (87.3%; 95% CI, 82.9–91.6) and cardiovascular involvement such as myocardial dysfunction (55.3%; 95% CI, 42.4–68.2), coronary artery aneurysms (21.7%; 95% CI, 12.8–30.1) and shock (65.8%; 95% CI, 51.1–80.4), with marked elevated inflammatory and cardiac markers. The majority of patients received intravenous immunoglobulin (81.0%; 95% CI, 75.0–86.9), aspirin (67.3%; 95% CI, 48.8–85.7), and corticosteroids (63.6%; 95% CI, 53.4–73.8) with a variety of anti‐inflammatory agents. Although myocardial dysfunction improved in 55.1% (95% CI, 33.4–76.8) at discharge, the rate of extracorporeal membrane oxygenation use was 6.3% (95% CI, 2.8–9.8) and the mortality was 1.9% (95% CI, 1.0–2.8).Conclusion: Our findings suggest that MIS‐C leads to multiple organ failure, including gastrointestinal manifestations, myocardial dysfunction and coronary abnormalities, and has distinct features from Kawasaki disease.

Genetics of congenital heart disease: a narrative review of recent advances and clinical implications Jun Yasuhara, Vidu Garg

SARS-CoV-2 infection and COVID-19–related illnesses have affected all age groups and caused over 6.5 million deaths across the globe as of September 2022.¹ During the early phase of the COVID-19 pandemic, studies showed that children with COVID-19 tended to present with milder symptoms than adults.² However, as the pandemic progressed, emerging evidence suggested that children were still at risk of developing severe illnesses and complications from COVID-19, including respiratory failure, myocarditis, and multisystem inflammatory syndrome in children (MIS-C).^3-5