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Severe Gastrointestinal Features in Children with Covid-19: A Multicenter Retrospective Cohort Study

22 Pages Posted: 12 May 2021

See all articles by Andrea Lo Vecchio

Andrea Lo Vecchio

CSEF - University of Naples Federico II - Section of Pediatrics

Silvia Garazzino

University of Turin - Paediatric Infectious Diseases Unit

Andrea Smarrazzo

Ospedale Bambino Gesù IRCCS

Elisabetta Venturini

Infection Disease Unit, Meyer Children’s University Hospital

Marco Poeta

CSEF - University of Naples Federico II - Section of Pediatrics

Paola Berlese

Treviso General Hospital - Department of Pediatrics

Marco Denina

Pediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin

Antonella Meini

Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia

Samantha Bosis

Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico

Luisa Galli

University of Florence - Meyer Children’s Hospital

Salvatore Cazzato

Salesi Children's Hospital - Department of Mother and Child Health - Pediatric Unit

Giangiacomo Nicolini

UOC Pediatria, San Martino Hospital

Gianluca Vergine

Infermi Hospital - Ospedale degli Infermi di Rimini - UOC Pediatria

Roberta Giacchero

UOC Pediatria ASST di Lodi

Giuseppina Ballardini

Ospedale Castelli - UOC Pediatria

Icilio Dodi

Infectious Diseases Unit, Pietro Barilla Children’s Hospital, University of Parma

Filippo Maria Salvini

Grande Ospedale Metropolitano Niguarda

Paolo Manzoni

Ospedale degli Infermi - Division of Pediatrics and Neonatology - Department of Maternal, Neonatal, and Infant Health

Giuliana Ferrante

University of Palermo

Vera Quadri

ASST Papa Giovanni XXIII

Andrea Campana

Bambino Gesù Children's Hospital - Academic Department of Pediatrics

Raffaele Badolato

University of Brescia - Department of Clinical and Experimental Sciences

Alberto Villani

Bambino Gesù Children's Hospital

Alfredo Guarino

CSEF - University of Naples Federico II - Section of Pediatrics

Guido Castelli Gattinara

Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS

Italian SITIP-SIP Pediatric SARS-CoV-2 Infection Study Group

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Abstract

Background: Severe gastrointestinal (GI) involvement has been occasionally reported in children with SARS-CoV-2 infection or among those with multisystem inflammatory syndrome (MIS-C). We aimed to investigate the clinical, radiological and histopathological GI characteristics in order to identify factors associated with severe outcome.

Methods: In this multicenter retrospective nationwide cohort study, symptomatic children with laboratory confirmed SARS-CoV-2 infection or MIS-C were enrolled. Children who received a diagnosis of acute abdomen, appendicitis, intussusception, pancreatitis, diffuse adeno-mesenteritis or abdominal fluid collections requiring surgical consultation and temporally correlated with SARS-CoV-2 infection were classified as having a severe GI involvement. Logistic regression models were used to estimate odds ratios (OR [95% confidence intervals]) between potential explanatory factors and severe outcome.

Findings: 685 children were enrolled between February 2020 and January 2021. The presence of GI symptoms was associated with a higher chance of hospital admission (OR 2·64 [1·89–3·69]) and of intensive care support (OR 3·90 [1·98–7·68]). Overall, 65 children (9.5%) showed a severe GI involvement featuring atypical presentations including disseminated adeno-mesenteritis (39·6%), appendicitis (33·5%), abdominal fluid collections (21·3%), pancreatitis (6·9%) or ileal intussusception (4·6%). Twenty-seven (42%) of these children underwent surgery, and remarkably only half of clinically suspected appendicitis were histologically confirmed. Children aged 5-10 years (OR 8·33 [2·62–26·5]) or > 10 years of age (OR 6·37 [2·12-19·1]) had a higher chance of severe outcome, compared to preschool-age children. Severe GI outcomes were more frequent in patients with abdominal pain (aOR 34·5 [10·1–118]), lymphopenia (aOR 8·93 [3·03-26·3]) or MIS-C (aOR 6·28 [1·92–20·5]). Diarrhea was associated with a higher chance of adeno-mesenteritis (aOR 3·13 [1·08–9·12]) and abdominal fluid collections (aOR 3·22 [1·03-10]).

Interpretation: About 10% of symptomatic children with COVID-19 may have severe GI involvement, frequently associated with MIS-C. Early identification of at-risk patients can improve the management of serious complications.

Funding Information: SARS-CoV-2, gastrointestinal tract, gut, COVID-19, children, MIS-C

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: This study was undertaken in accordance with good clinical practice guidelines and the Declaration of Helsinki. Written informed consent was obtained from parents/caregivers, and the patient if appropriate. The study protocol was approved by the Ethical Committee of the coordinating center (protocol number 0031296) as well as by independent ethics committees and/or institutional review boards of any single enrolling center.

Keywords: SARS-CoV-2, gastrointestinal tract, gut, COVID-19, children, MIS-C

Suggested Citation

Lo Vecchio, Andrea and Garazzino, Silvia and Smarrazzo, Andrea and Venturini, Elisabetta and Poeta, Marco and Berlese, Paola and Denina, Marco and Meini, Antonella and Bosis, Samantha and Galli, Luisa and Cazzato, Salvatore and Nicolini, Giangiacomo and Vergine, Gianluca and Giacchero, Roberta and Ballardini, Giuseppina and Dodi, Icilio and Salvini, Filippo Maria and Manzoni, Paolo and Ferrante, Giuliana and Quadri, Vera and Campana, Andrea and Badolato, Raffaele and Villani, Alberto and Guarino, Alfredo and Castelli Gattinara, Guido and Infection Study Group, Italian SITIP-SIP Pediatric SARS-CoV-2, Severe Gastrointestinal Features in Children with Covid-19: A Multicenter Retrospective Cohort Study (5/10/2021). Available at SSRN: https://ssrn.com/abstract=3844828 or http://dx.doi.org/10.2139/ssrn.3844828

Andrea Lo Vecchio (Contact Author)

CSEF - University of Naples Federico II - Section of Pediatrics ( email )

Via Pansini 5
Naples, 80131
Italy
0039 081 7463365 (Phone)
0039 081 7464232 (Fax)

Silvia Garazzino

University of Turin - Paediatric Infectious Diseases Unit ( email )

Turin
Italy

Andrea Smarrazzo

Ospedale Bambino Gesù IRCCS ( email )

Rome
Italy

Elisabetta Venturini

Infection Disease Unit, Meyer Children’s University Hospital ( email )

Marco Poeta

CSEF - University of Naples Federico II - Section of Pediatrics ( email )

Naples, 80131
Italy

Paola Berlese

Treviso General Hospital - Department of Pediatrics

Treviso
Italy

Marco Denina

Pediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin ( email )

Antonella Meini

Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia ( email )

Samantha Bosis

Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ( email )

Luisa Galli

University of Florence - Meyer Children’s Hospital ( email )

Firenze
Italy

Salvatore Cazzato

Salesi Children's Hospital - Department of Mother and Child Health - Pediatric Unit ( email )

Ancona
Italy

Giangiacomo Nicolini

UOC Pediatria, San Martino Hospital ( email )

Gianluca Vergine

Infermi Hospital - Ospedale degli Infermi di Rimini - UOC Pediatria

Rimini
Italy

Roberta Giacchero

UOC Pediatria ASST di Lodi ( email )

Giuseppina Ballardini

Ospedale Castelli - UOC Pediatria ( email )

Verbania
Italy

Icilio Dodi

Infectious Diseases Unit, Pietro Barilla Children’s Hospital, University of Parma ( email )

Filippo Maria Salvini

Grande Ospedale Metropolitano Niguarda ( email )

Milan
Italy

Paolo Manzoni

Ospedale degli Infermi - Division of Pediatrics and Neonatology - Department of Maternal, Neonatal, and Infant Health

Biella
Italy

Giuliana Ferrante

University of Palermo ( email )

Viale delle Scienza
Palermo, Palermo 90128
Italy

Vera Quadri

ASST Papa Giovanni XXIII ( email )

Piazza OMS
Organizzazione Mondiale della Sanità, 1
Bergamo, 24127
Italy

Andrea Campana

Bambino Gesù Children's Hospital - Academic Department of Pediatrics ( email )

Italy

Raffaele Badolato

University of Brescia - Department of Clinical and Experimental Sciences ( email )

Brescia
Italy

Alberto Villani

Bambino Gesù Children's Hospital ( email )

Alfredo Guarino

CSEF - University of Naples Federico II - Section of Pediatrics

Naples, 80131
Italy

Guido Castelli Gattinara

Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS ( email )

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