Post COVID-19 Cardio-Vascular Complications in Pediatric Cases: A Systematic Review

Abstract

Introduction: The main reported cause of death in COVID-19 patients is respiratory failure, with cardiac dysfunction identified as the subsequent leading cause of mortality. In this manuscript, our objective is to provide a comprehensive overview of the existing knowledge regarding the potential cardiovascular implications in the pediatric cases of COVID-19 infection. Method: This study was performed in compliance with PRISMA-NMA and the international guidelines on clinical investigation of the World Medical Association’s Declaration of Helsinki; PICO: (P)opulation was pediatrics (age <18), (I)ntervention/Exposure was COVID-19 infection, (C)omparison was done with the group of pediatrics who didn't develop to COVID-19, and (O)utcome was considered as any cardiovascular complication. Literature searched from January 1st, 2020 until January 21st, 2024 using PubMed, Scopus, and Web of Science databases. The identified articles were allocated between two reviewers for screening, then, the full-texts were assessed. Finally, data extraction and quality assessment of included studies were performed. Result: Among 2383 studies, 1795 were selected for title/ abstract screening. Then, 157 of those were considered for full-text screening. Such a process was applied for manual search, and three papers were entered for final analysis. Ultimately, 26 papers underwent data extraction and quality analysis. Totally, 9023 participants were considered; mean age was 9.5 years, and 54.33% were male, 2022 (22.4%) had at least one sign indicating any comorbidities. Totally, 667 patients were referred by shock; meanwhile, ECG alterations, increased cardiac Troponin, and pro-BNP were detected in 382 (4.2%), 403 (4.46%), and 459 (5.08%) respectively. Most of the patients (14.5%) presented with myocardial dysfunction; however, coronary artery involvement was noted within 815 (9%) children. Management with inotropic medication and extracorporeal membrane oxygenation was documented in 17.3% and 9.5% pediatric cases. At the end of the evaluation period, 61 (0.6%) patients ended up with death, and others were discharged. Among those 542 (6%) cases had cardiac sequel but 8419 (93.3%) patients were fully recovered. Conclusion: Each child who requires hospitalization due to his critical condition in the context of COVID-19 needs to be evaluated for the presence of cardiac disorders during their hospitalization and in future follow ups.