LCL Kids

Although vertical transmission of SARS-CoV-2 from mother to fetus is rare, the neurodevelopmental impact of in utero SARS-CoV-2 exposure on infants needs further elucidation.

Objective

To investigate the neurodevelopmental outcomes at 12 and 22 corrected age among infants who had exposure to confirmed maternal SARS-CoV-2 infection during pregnancy.

Results

A total of 142 infants were recruited and included in the study. Of those, a one-month assessment was completed in 141 (99%), a 12-month assessment completed in 63 (44%), and a 22-month assessment completed in 44 (31%) infants. At one month, most infants had no medical concerns; 11 infants were re-admitted to the hospital within the first month of life, predominantly for hyperbilirubinemia. At 12 months, median ASQ and CSBS scores were above standardized cut-offs for development across all developmental domains. At 22 months, while the median standard cognitive, language, and motor scores were within the average classification (25–37th percentile), twenty-three (52%) infants presented with developmental impairment (score <85); 13 (30%) in motor, 17 (39%) in language, and 13 (30%) in cognitive domains. Nine (20%) infants were below cut-off for all three domains. Multivariable logistic modelling did not identify an independent relationship between trimester of SARS-CoV-2 acquisition or positive SARS-CoV-2 test at delivery and the presence of developmental delay on BSID-IV in any domain. No child had hearing impairment or blindness.

Read Study

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe postinfectious complication of SARS-CoV-2 infection, frequently requiring admission to an intensive care unit. Both the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) define MIS-C as a hyperinflammatory condition characterized by fever, markedly elevated inflammatory markers, and multisystem organ involvement in the absence of an alternative plausible diagnosis.^1,2 Since its first recognition in 2020, MIS-C has been reported worldwide, with mortality ranging from 1% to 2% and up to 67% of affected children requiring vasopressor or ventilatory support.^3–6 In the United States alone, national surveillance has identified more than 9783 cases of MIS-C and more than 80 associated deaths as of September 2025, with disproportionately higher incidence among Black and Hispanic children.⁷ Despite declining incidence, MIS-C remains a clinically relevant condition with potential long-term sequelae, necessitating deeper understanding to guide effective treatment and morbidity-prevention strategies.

Read Study

Children and adolescents who are reinfected with SARS-CoV-2 face a significantly higher risk of developing long COVID, according to a large, multi-institutional study published in The Lancet Infectious Diseases. 

The study, which analyzed electronic health record data from 40 children’s hospitals and health systems across the United States, found that young patients who experienced a second confirmed SARS-CoV-2 infection during the omicron period were more than twice as likely to receive a clinician-documented diagnosis of post-acute sequelae of COVID-19 (PASC) as those in the same calendar period after a first infection. 

“This work comes out of the NIH-funded RECOVER Initiative, which was established to understand the long-term consequences of SARS-CoV-2 infection,” said David Liebovitz, MD, professor of Medicine in the Division of General Internal Medicine, and a co-author of the study. “Earlier work helped define long COVID in children after a first infection, but once omicron became dominant and reinfections became routine, a pressing clinical question emerged: does getting COVID a second time carry its own distinct risk of long COVID, or does prior infection confer meaningful protection? Existing pediatric evidence was thin, mostly based on small survey-based studies with self-reported outcomes and limited ability to control for confounders.”

Read Article

Most children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have mild or minimal disease, with a small proportion developing severe disease or multisystem inflammatory syndrome in children (MIS-C). Complement-mediated thrombotic microangiopathy (TMA) has been associated with SARS-CoV-2 infection in adults but has not been studied in the pediatric population. We hypothesized that complement activation plays an important role in SARS-CoV-2 infection in children and sought to understand if TMA was present in these patients. We enrolled 50 hospitalized pediatric patients with acute SARS-CoV-2 infection (n = 21, minimal coronavirus disease 2019 [COVID-19]; n = 11, severe COVID-19) or MIS-C (n = 18). As a biomarker of complement activation and TMA, soluble C5b9 (sC5b9, normal 247 ng/mL) was measured in plasma, and elevations were found in patients with minimal disease (median, 392 ng/mL; interquartile range [IQR], 244-622 ng/mL), severe disease (median, 646 ng/mL; IQR, 203-728 ng/mL), and MIS-C (median, 630 ng/mL; IQR, 359-932 ng/mL) compared with 26 healthy control subjects (median, 57 ng/mL; IQR, 9-163 ng/mL; P < .001). Higher sC5b9 levels were associated with higher serum creatinine (P = .01) but not age. Of the 19 patients for whom complete clinical criteria were available, 17 (89%) met criteria for TMA. A high proportion of tested children with SARS-CoV-2 infection had evidence of complement activation and met clinical and diagnostic criteria for TMA. Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C.

Read Study