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Children's Hospital monitoring complications weeks after COVID-19 recovery

An ambulance vehicle with Tallinn Children's Hospital branding.
An ambulance vehicle with Tallinn Children's Hospital branding. Source: ERR

The coronavirus experience at Tallinn Children's Hospital shows that the younger the child, the easier it is to handle the virus, but some young children begin showing serious complications requiring hospital treatment weeks after recovering from the illness.

During 2021, 62 small patients have been given treatment in the Tallinn Children's Hospital. Not all children going to the emergency medicine center (EMO) with a coronavirus suspicion need treatment and giving parents guidance on how to treat their child is good enough in most situations. There are far more of these cases than the 62 patients admitted to the hospital.

Dr. Reet Raukas, chief of the Children's Hospital's paediatrics clinic, said children tend to go through the illness lightly and the average hospital stay is around 3.5 days, much shorter than adults.

"The ages range from a few weeks old to 17-year olds. Babies who are less than a month old have often had someone in their family get infected and the baby has gotten infected from them, they get a fever and then the family turns to the hospital, the child is stabilized and sent back home. The picture for 17-year olds however is more like that of adults: cough, breathing difficulties, pneumonia," Raukas told ERR.

The babies who are taken to EMO tend to have other issues instead - perhaps the child does not eat, they are sluggish or just different than usual. The Children's Hospital then discovers them to have the coronavirus.

Although there are still some women who are infected while giving birth, there are no cases of transmission from mother to child in Estonia registered yet. This has led to the youngest COVID-19 patients to be a few weeks old instead.

"Infants have had the illness at little cost. Babies one or two months old have mostly had fevers. Parents turn to us with a fever on the first day, we help reduce it and give some treatment," Dr. Raukas said.

She added that the illness progression often expresses in severe indigestion when it comes to older children and that is also the main reason why they need treatment: they vomit, have diarrhea, and as a result, dehydration.

"While rota and nora viruses are spreading, it seems like gastrointestinal tract symptoms should be paid attention to. If it is a small child, who is constantly vomiting, mothers and fathers cannot give them enough fluids at home. It is easier to restore their liquid balance through the vein," Raukas noted.

So children with unaffected immune systems tend to handle the virus rather well. The more serious cases have come from situation where the child has underlying conditions, however. This has led to one young girl receiving remdesivir, which is also used as treatment for respiratory failure in adults.

"The reason for why she turned to the hospital was her completely different illness - leukemia. The family was already positive for COVID-19, she also received a diagnosis two days later. She received cancer treatment, but developed pneumonia in her second week in hospital," Raukas said.

The girl in question recovered from the coronavirus and is continuing her battle with leukemia. A similar case has happened for a child who has diabetes.

A Tallinn Children's Hospital reanimobile vehicle. Source: Tallinn Children's Hospital

More and more serious complications

While the illness itself has not affected children too much, complications have become more of a worrying factor recently, often developing among kindergarten and primary education children weeks after recovering from the coronavirus that often did not even need treatment in hospital.

"The French began describing in May-June that children develop serious systemic illnesses after having the coronavirus. Now, in February, we see it too: two to six weeks after having the coronavirus, children develop severe multisystem inflammatory reaction," Dr. Raukas explained.

This condition mainly brings forth a high fever, accompanied with a high blood inflammation indicator, a specific rash on the arms and legs, redness on the lips and eyes, swelling of the hands and feet and abdominal pain with diarrhea and vomiting. In addition to the headache and cough. Those are symptoms parents can identify first and turn to the hospital.

"The cardiovascular system is damaged, coronary and muscular disorders develop after that. As the illness progresses, kidney failure, liver problems, changes in blood clotting may also occur," Raukas listed.

"The first boy with that diagnosis, a school boy aged 6 or 7, had a runny nose during Christmas, he was not tested prior. When he got to the hospital in serious condition in February, he had very high coronavirus antibody indicators, there was an obvious relation to having had the coronavirus earlier," Raukas said.

This multisystem inflammatory reaction as a coronavirus complication is a serious condition, needing multiple weeks of treatment. As of Thursday, there have been eight children admitted to hospital with the diagnosis and two are currently receiving treatment. All eight children are aged in the kindergarten and primary education range.


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Editor: Kristjan Kallaste

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