Cardiac Findings in Pediatric Patients With Multisystem Inflammatory Syndrome in Children Associated With COVID-19

Background The overall severity of cardiac disease secondary to acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection in children appears to be much lower when compared with adults. However, the newly described multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been associated with cardiac complications. Methods We reviewed the clinical course and cardiac testing results in pediatric patients hospitalized with MIS-C at 2 large hospital systems in the New York City metropolitan area over a 3-month period. Results Of the 33 patients (median age 2.8 years) in the study cohort, 24 (73%) had at least one abnormality in cardiac testing: abnormal electrocardiogram (48%), elevated brain natriuretic peptide (43%), abnormal echocardiogram (30%), and/or elevated troponin (21%). Electrocardiogram and echocardiogram abnormalities all resolved by the 2-week outpatient follow-up cardiology visit. Conclusion While 73% of pediatric patients with MIS-C had evidence of abnormal cardiac testing on hospital admission in our study, all cardiac testing was normal by outpatient hospital discharge follow-up. Cardiac screening tests should be performed in all patients diagnosed with MIS-C given the high rate of abnormal cardiac findings in our study cohort.

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Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

Cardiology in the Young ◽

10.1017/s1047951121003024 ◽

2021 ◽

pp. 1-9

Author(s):

Ashraf S. Harahsheh ◽

Anita Krishnan ◽

Roberta L. DeBiasi ◽

Laura J. Olivieri ◽

Christopher Spurney ◽

...

Keyword(s):

Coronary Artery ◽

Pericardial Effusion ◽

Acute Phase ◽

Systolic Dysfunction ◽

Interquartile Range ◽

High Rate ◽

Cardiac Complications ◽

Valvular Regurgitation ◽

Coronary Artery Abnormalities ◽

Inflammatory Syndrome

Abstract Background: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. Objectives: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. Methods: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum. Results: Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). Conclusion: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

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Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00236-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Anh Hong Nguyen ◽

Bethlehem Mekonnen ◽

Eric Kim ◽

Nisha R. Acharya

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

San Francisco ◽

Pediatric Patients ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Study Cohort ◽

Common Diagnosis ◽

Corticosteroid Injections

Abstract Background Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients. Methods Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema. Results The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7). By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3–6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3–12.2, P = 0.01). Conclusions Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

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The transsphenoidal resection of pediatric craniopharyngiomas: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.7.peds09252 ◽

2010 ◽

Vol 5 (1) ◽

pp. 49-60 ◽

Cited By ~ 69

Author(s):

John A. Jane ◽

Daniel M. Prevedello ◽

Tord D. Alden ◽

Edward R. Laws

Keyword(s):

Transsphenoidal Surgery ◽

Pediatric Patients ◽

Pediatric Population ◽

Case Series ◽

High Rate ◽

Subtotal Resection ◽

Consecutive Series ◽

Entire Cohort ◽

Transsphenoidal Resection

Object The majority of pediatric craniopharyngiomas are treated using a transcranial approach. Although there is an increasing acceptance of transsphenoidal resection in adults, there are few reports describing this approach in the pediatric population. The purpose of this study is to report the outcomes after transsphenoidal surgery in a consecutive series of pediatric patients with craniopharyngiomas treated at a single institution with the goal of gross-total resection (GTR). Methods Twenty-three patients with pathologically proven craniopharyngiomas were identified who were 18 years of age or less at the time of surgery. The medical records and imaging studies of the patients were retrospectively reviewed. One patient who was lost to follow-up after surgery was excluded. Results Among the 22 patients included in the study, 11 underwent transsphenoidal surgery as the primary procedure and 11 underwent transsphenoidal surgery as a secondary procedure after a previous procedure. All patients had at least some sellar component to their tumor and all had either anterior or posterior pituitary dysfunction at presentation. In the entire cohort, a GTR was achieved in 15 (68%) of 22 patients, a radical subtotal resection in 4 (18%) of 22 patients, a subtotal resection in 1 patient, and a partial resection in 2 patients. The degree of resection was higher in the primary transsphenoidal group. After a mean follow-up of 82 months, 4 patients (18%) experienced recurrence. Recurrence occurred in 13% after GTR compared with 28.5% after all other degrees of resection. Tumor recurred in 9% of the primary transsphenoidal group and in 30% of patients who had undergone other therapies prior to the transsphenoidal operation. No patient who had panhypopituitarism experienced a gain of function postoperatively, 67% developed new panhypopituitarism, and 56% experienced new diabetes insipidus. Vision improved or normalized in 9 (64%) of 14 patients presenting with visual loss. Complications included 1 death 3 weeks postoperatively, 2 CSF leaks, and new obesity in 37%. Conclusions Transsphenoidal resection of pediatric craniopharyngiomas results in a high rate of both visual improvement and GTR with a low associated risk of recurrence. The transsphenoidal approach should be considered in selected pediatric patients with craniopharyngioma, especially those with infradiaphragmatic origin.

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A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽

10.2478/prilozi-2021-0027 ◽

2021 ◽

Vol 42 (2) ◽

pp. 95-101

Author(s):

Lidija Kareva ◽

Katarina Stavrik ◽

Kristina Mironska ◽

Arjeta Hasani ◽

Sonja Bojadzieva ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Close Contact ◽

Multiorgan Failure ◽

Gastrointestinal Symptoms ◽

Gastrointestinal Diseases ◽

Serological Testing ◽

Inflammatory Syndrome ◽

Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

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Combined presentation of severe pulmonary COVID-19 and multisystem inflammatory syndrome in children (MIS-C): two reported Egyptian pediatric cases

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00076-w ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Tarek Hamed ◽

Dina T. Sarhan

Keyword(s):

Critical Illness ◽

Inflammatory Markers ◽

Immune Modulation ◽

Pediatric Patients ◽

Clinical Findings ◽

Case Presentation ◽

Clinical Criteria ◽

Inflammatory Syndrome ◽

Lung Ct

Abstract Background Initial reports from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease (COVID-19) than adults. Later on, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe pulmonary COVID-19 and MIS-C. Both are described as two distinct conditions, and the differentiation between them was the scope of many studies. In this report from Egypt, we will describe two unique pediatric cases presented by combined manifestations of severe pulmonary COVID-19 and MIS-C. Case presentation Two patients presented with severe pulmonary COVID-19 evident by pulmonary symptoms, signs, and advanced CO-RADS stage in lung CT were simultaneously fulfilling the clinical criteria of MIS-C including fever, multi-system affection, increased inflammatory markers in addition to the proved COVID-19 by positive serologic tests for SARS-CoV-2 but PCR was negative. Both patients responded well to immune-modulation therapy by IVIG and steroids and discharged well under closed follow-up. Conclusions Although it is debatable to present simultaneously, MIS-C should be considered in patients presenting with typical clinical findings and concerns for pulmonary COVID-19 once the criteria for MIS-C diagnosis is fulfilled. Starting treatment without delay can favor better prognosis.

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Post-Discharge Telephonic Follow-Up of Pediatric Patients Affected by SARS-CoV2 Infection: A Safe and Feasible Way to Monitor Children After Hospitalization. The Experience of a Single Italian Pediatric COVID Center.

10.21203/rs.3.rs-146702/v1 ◽

2021 ◽

Author(s):

Vitangelo Clemente ◽

Costanza Tripiciano ◽

Patrizio Moras ◽

Daniele Deriu ◽

Martina Di Giuseppe ◽

...

Keyword(s):

Pediatric Patients ◽

Social Issues ◽

Pediatric Hospital ◽

Post Discharge ◽

Pharyngeal Swab ◽

Viral Shedding ◽

Discharge From Hospital ◽

Inflammatory Syndrome

Abstract BackgroundSARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring.Materials and Methods65 children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs.ResultsDuring the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. 1 patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days.ConclusionOur experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

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Complications of Tibial Tubercle Surgery

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00077 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0007 ◽

Cited By ~ 1

Author(s):

Anna Lundeen ◽

Elizabeth A. Arendt ◽

Kristin Mathson ◽

Julie Agel ◽

Jeffrey A. Macalena

Keyword(s):

Current Literature ◽

Complication Rate ◽

High Rate ◽

Tibial Tubercle ◽

Study Cohort ◽

Trochlear Groove ◽

Complication Rates ◽

Cutaneous Sensation ◽

Lateral Patella

Objectives: Tibial tubercle osteotomy (TTO) is a common procedure that is frequently used in the treatment of recurrent patellar instability and/or patellar chondrosis. Medialization of the tubercle decreases the lateral quadriceps vector of the patella resulting in load shifting away from the lateral patella. Distalization of the tubercle decreases patella height and allows for earlier containment of the patella in the bony walls of the trochlear groove. Anteriorization has been shown to be an effective treatment to unload the inferior lateral patella when chondrosis of the patella is present in this region. Current estimates of this procedure’s complication rates range from 0% to 11%. The purpose of this study was to review the complication rate following TTO performed within an academic sports medicine practice. The hypothesis was that complication rate for TTO is greater than 10% and that the rate of complications with distalization exceeds that of medialization alone. Methods: All patients between May 2009 and May 2015 who underwent a TTO were retrospectively identified. Those with at least 6 months of follow up or a complication within the first 3 months were included for data analysis. Complications were identified and labeled as either major or minor. Major complications were defined as fracture of the tibia, deep infection requiring surgical debridement, nonunion requiring revision fixation, delayed union requiring bone graft, bone stimulation, or screw exchange, arthrofibrosis requiring manipulation under sedation and/or open lysis of adhesions, loss of fixation of the tubercle fragment, and deep vein thrombosis (DVT) whereas minor complications were defined as removal of symptomatic hardware, superficial wound infection, disturbance of cutaneous sensation, and delay in wound healing not requiring surgery. Results: During the study period, 126 TTO were performed. Representing the study cohort are 111 patients, who have at least 6 months of follow up or a complication within 3 months. The mean follow up was 23 months. There were 62 of 126 (49.2%) TTO performed for patellofemoral instability and 23 of 126 (18.2%) for patellofemoral chondral damage. Thirty-eight osteotomies were performed for both instability and cartilage damage (30.2%). Two osteotomies were performed solely for patella alta and one TTO was performed for unspecified reason (2.4%). Of the complications, 28 came following distalization of the tubercle and 4 of these complications represent subsequent tibia fracture. Overall, the complication rate was 28.7 percent; major (17.1%) and minor (11.6%) complication rates are shown in Table 1. Subgroup analysis shows a complication rate of 54% for tubercles that were distalized versus 46% for medialization alone. Conclusion: The rate of total complication for TTO was 28.7%, this is greater than the estimated rate of complication in the current literature. Further, the rate of complications when the tibial tubercle was distalized was greater than when medialized alone suggesting that special considerations be made with this cohort. This high rate of complication is accompanied by a high rate of arthrofibrosis when compared to current literature suggesting the need for preoperative discussion as well as a detailed plan for postoperative rehabilitation to improve motion in patients and decrease the need for subsequent intervention. This study’s findings may redirect patient and physician discussions regarding risks of tibial tubercle osteotomies. [Table: see text]

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Cardiac Abnormalities Seen in Pediatric Patients During the SARS‐CoV2 Pandemic: An International Experience

Journal of the American Heart Association ◽

10.1161/jaha.120.018007 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Bradley C. Clark ◽

Joan Sanchez‐de‐Toledo ◽

Carles Bautista‐Rodriguez ◽

Nadine Choueiter ◽

Diego Lara ◽

...

Keyword(s):

Pediatric Patients ◽

The United States ◽

Left Ventricular ◽

Medical Community ◽

Healthy Children ◽

Av Block ◽

Coronary Abnormalities ◽

Cardiac Manifestations ◽

Inflammatory Syndrome

Abstract Background During the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. Conclusions We describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

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Revision rate of pediatric ventriculoperitoneal shunts after 15 years

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.9.peds1298 ◽

2013 ◽

Vol 11 (1) ◽

pp. 15-19 ◽

Cited By ~ 104

Author(s):

Jonathan J. Stone ◽

Corey T. Walker ◽

Maxwell Jacobson ◽

Valerie Phillips ◽

Howard J. Silberstein

Keyword(s):

Transition To Adulthood ◽

Pediatric Patients ◽

Medical Center ◽

High Rate ◽

Shunt Revision ◽

Congenital Defects ◽

Vp Shunt ◽

Shunt Placement ◽

Catheter Occlusion

Object Ventriculoperitoneal (VP) shunt placement remains the mainstay treatment for pediatric hydrocephalus. These devices have a relatively high complication and failure rate, often requiring multiple revisions. The authors present a single institution's experience of pediatric patients treated with VP shunts. With an average follow-up time of 20 years, this study is among the longest reports of VP shunt revision in the literature to date. Hydrocephalus origins, shunt revision rates, and causes of shunt failure are described. Patients who underwent their first shunt revision more than 10 years after initial shunt placement were also explored. Methods A retrospective chart review was performed on all pediatric patients who underwent VP shunt placement from January 1990 through November 1996 at the University of Rochester Medical Center. Only patients who had at least 15 years of follow-up since their initial shunting procedure were included. Results A total of 234 procedures were performed on 64 patients, with a mean follow-up of 19.9 years. Patients ranged from a few days to 17.2 years old when they received their original shunt, with a median age of 4 months; 84.5% of the patients required 1 or more shunt revisions and 4.7% required 10 or more. Congenital defects, Chiari Type II malformations, tumors, and intraventricular hemorrhage were the most common causes of hydrocephalus. Overall, patients averaged 2.66 revisions, with proximal (27%) and distal (15%) catheter occlusion, disconnection (11%), and infection (9%) comprising the most common reasons for shunt malfunction. Notably, 12.5% of patients did not require their first shunt revision until more than 10 years after initial device placement, a previously undescribed finding due to the short follow-up duration in previous studies. Conclusions This long-term retrospective analysis of pediatric VP shunt placement revealed a relatively high rate of complications with need for shunt revision as late as 17 years after initial placement. Catheter occlusion represented a significant percentage of shunt failures. Cerebrospinal fluid shunting has a propensity for mechanical failure and patients with VP shunts should receive follow-up through the transition to adulthood.

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Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01065-w ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Vitangelo Clemente ◽

Costanza Tripiciano ◽

Patrizio Moras ◽

Daniele Deriu ◽

Martina Di Giuseppe ◽

...

Keyword(s):

Pediatric Patients ◽

Social Issues ◽

Pediatric Hospital ◽

Post Discharge ◽

Pharyngeal Swab ◽

Viral Shedding ◽

Discharge From Hospital ◽

Inflammatory Syndrome

Abstract Background SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. Materials and methods Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. Results During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. Conclusion Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

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