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      Where to make a difference: research and the social determinants in pediatrics and child health in the COVID-19 era

      brief-report
      Author(s):
      Publication date (Electronic):
      Journal: Pediatric Research
      Publisher: Nature Publishing Group US

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          Abstract

          The COVID-19 pandemic has emphasized the way different communities have been affected dependent on ethnic or social background. In this paper, the social determinants of COVID-19 will be considered with a review of the current literature and the opportunities for future research. There has been very little written about this approach to the infection and its consequences. Although children are not as affected as adults, the measures to control the pandemic may have significant consequences for children’s mental and physical well-being, as well as long-term challenges for their education. Research in pediatrics and child health should address this challenge going forward.

          Impact

          • Raises the importance of Social Determinants of Health in pediatrics.

          • Considers the impact of Social Determinants of Health on COVID-19.

          • Offers opportunities for research in the future.

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          Most cited references34

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          Mental Health and the Covid-19 Pandemic

          Betty Pfefferbaum, Carol North (2020)
          Article 0 comments Cited 1779 times – based on 0 reviews     Review now
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            Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

            Leora Feldstein, Erica Rose, Steven M. Horwitz … (2020)
            Abstract Background Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. Methods We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. Results We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). Conclusions Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)
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              Multisystem Inflammatory Syndrome in Children in New York State

              Elizabeth M Dufort, Emilia H. Koumans, Eric Chow … (2020)
              Abstract Background A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. Methods Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. Results As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. Conclusions The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.
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                Author and article information

                Contributors
                Peter Lachman:
                ORCID: http://orcid.org/0000-0001-5120-5776
                plachman@isqua.org
                Journal
                Journal ID (nlm-ta): Pediatr Res
                Journal ID (iso-abbrev): Pediatr Res
                Title: Pediatric Research
                Publisher: Nature Publishing Group US (New York )
                ISSN (Print): 0031-3998
                ISSN (Electronic): 1530-0447
                Publication date (Electronic): 10 November 2020
                Pages: 1-4
                Affiliations
                GRID grid.475893.4, ISNI 0000 0004 0500 5900, International Society for Quality in Health Care, ; 4th Floor, Huguenot House, 35-38 St Stephens Green, Dublin, D02 NY63 Ireland
                Author information
                http://orcid.org/0000-0001-5120-5776
                Article
                Publisher ID: 1253
                DOI: 10.1038/s41390-020-01253-0
                PMC ID: 7654351
                PubMed ID: 33173180
                SO-VID: 81b4c298-fe33-4449-bcd9-9d1d55edc7b6
                Copyright © © International Pediatric Research Foundation, Inc 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 29 July 2020
                Date revision received : 3 October 2020
                Date accepted : 13 October 2020
                Categories
                Subject: Comment

                ScienceOpen disciplines: Pediatrics
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                ScienceOpen disciplines: Pediatrics

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