Tag Archive for: COVID-19

pregnant woman talking to doctor

Prenatal COVID exposure associated with changes in newborn brain

pregnant woman talking to doctor

The team found differences in the brains of both infants whose mothers were infected with COVID while pregnant, as well as those born to mothers who did not test positive for the virus.

Babies born during the COVID-19 pandemic have differences in the size of certain structures in the brain, compared to infants born before the pandemic, according to a new study led by researchers at Children’s National Hospital.

The team found differences in the brains of both infants whose mothers were infected with COVID while pregnant, as well as those born to mothers who did not test positive for the virus, according to the study published in Cerebral Cortex.

The findings suggest that exposure to the coronavirus and being pregnant during the pandemic could play a role in shaping infant brain development, said Nickie Andescavage, M.D., the first author of the paper and associate chief for the Developing Brain Institute at Children’s National.

The fine print

The study’s authors looked at three groups of infants: 108 born before the pandemic; 47 exposed to COVID before birth; and 55 unexposed infants. In all cases, researchers performed magnetic resonance imaging (MRI) scans of the newborns’ brains during the first few weeks of life. The MRI scans, which are non-invasive and do not expose patients to radiation, provided 3D images of the brain, allowing doctors to calculate the volume of different areas.

Researchers found several differences in the brains of babies exposed to COVID. They had larger volumes of the gray matter that makes up the brain’s outermost layer, compared to the two other groups. In contrast, an inner area of the brain, known as deep gray matter, was smaller than in unexposed babies. These are areas that contain large numbers of neurons that generate and process signals throughout the brain. “Their brains formed differently if they were exposed to COVID,” said Dr. Andescavage, adding that “those exposed to COVID had unique signatures” in the brain.

Doctors also measured the depths of the folds in the babies’ brains – a way to determine how the brain is maturing during early development. Babies born to mothers who had COVID in pregnancy had deeper grooves in the frontal lobe, while babies born during the pandemic – even without being exposed to COVID – had increased folds and grooves throughout the brain, compared to babies born before the pandemic. “There was something about being born during the pandemic that changed how the brain developed,” Dr. Andescavage said.

What’s ahead

The study authors can’t fully explain what caused the differences in brain development in these babies, Dr. Andescavage said. But other studies have linked maternal stress and depression to changes in the newborn brain. In a future study, Dr. Andescavage and her colleagues will examine the relationship between infant brain development and how stress and anxiety during the pandemic may have played a role in early development.

Because the babies in the study were just a few weeks old, researchers don’t know if their altered brain development will affect how they learn or behave. Researchers plan to follow the children until age 6, allowing them to observe whether pandemic-era babies hit key developmental milestones on time, such as walking, talking, holding a crayon and learning the alphabet.

Researchers have been worried about the effect of COVID on the fetus since the beginning of the pandemic. Studies show that babies exposed to COVID in the womb may experience developmental impacts, and research is underway to better understand long-term outcomes.

Although the coronavirus rarely crosses the placenta to infect the fetus directly, there are other ways maternal infection can influence the developing baby. Dr. Andescavage said inflammation is one potential harm to a developing baby. In addition, if a pregnant woman becomes so sick that the levels of oxygen in her blood fall significantly, that can deprive the fetus of oxygen, she added.

In recent decades, studies of large populations have found that maternal infections with influenza and other viruses increased the risk of serious problems in children even years later, including autism, attention deficit hyperactivity disorder and schizophrenia, although the reasons behind the association are not well understood. Technology may allow doctors to answer a number of questions about COVID and the infant brain.

“With advanced imaging and MRI, we’re in a position now to be able to understand how the babies are developing in ways we never previously could,” Dr. Andescavage said. “That will better allow us to identify the exposures that may be harmful, and at what times babies may be especially vulnerable, to better position us to promote maternal wellness. This, in turn, helps infant wellness.”

stressed pregnant mom

Pandemic stress reshapes the placentas of expectant moms

stressed pregnant mom

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers.

Elevated maternal stress during the COVID-19 pandemic changed the structure, texture and other qualities of the placenta in pregnant mothers – a critical connection between mothers and their unborn babies – according to new research from the Developing Brain Institute at Children’s National Hospital.

Published in Scientific Reports, the findings spotlight the underappreciated link between the mental health of pregnant mothers and the health of the placenta – a critical organ that develops during pregnancy to nourish and protect babies. The long-term neurodevelopmental impact on their children is under investigation.

“During the pandemic, mothers were exposed to a litany of negative stressors including social distancing, fear of dying, financial insecurity and more,” said Catherine Limperopoulos, Ph.D., chief and director of the Developing Brain Institute, which led the research. “We now know that this vital organ was changed for many mothers, and it’s essential that we continue to investigate the impact this may have had on children who were born during this global public health crisis.”

The big picture

Dr. Limperopoulos’s team compared magnetic resonance imaging (MRI) of 165 women who were pregnant before March 2020 to 63 women who became pregnant during the pandemic. Those pregnant during the pandemic were not knowingly exposed to COVID-19, and they collectively scored significantly higher on questionnaires measuring stress and depression. They were recruited at Children’s National as part of a clinical trial aimed at reducing pregnant women’s elevated stress levels during the pandemic.

The placenta is a temporary organ that grows during pregnancy to provide oxygen, nutrients and immunological protection to babies, and its health is vital to the well-being of the developing fetus. The data showed key changes in how the placenta grew and developed among women pregnant during the pandemic, especially when compared to placental growth and development among women who were pregnant before the pandemic. Changes in placental development also were associated with the infant’s birth weight at delivery. Importantly, these changes seem to be connected to maternal stress and depression symptoms.

Taken as a whole, the findings suggest that the disturbances measured on placental development in the womb may influence the placenta’s ability to support fetal health and wellness. “We are continuing to follow up on these mother-baby dyads to determine the long-term functional significance of these placental changes in utero,” Dr. Limperopoulos said.

Studies have shown that the placenta adapts to negative changes in the maternal environment and mental health status, and disruptions in placental function impact infant brain development and children’s neurobehavior and temperament.

The patient benefit

Dr. Limperopoulos’s research studying childbirth amid the pandemic builds on her extensive work investigating the impact of maternal stress on unborn children, including its adverse effect on brain structure and biochemistry. She’s also working on treatments and interventions to better support new families. Her program, DC Mother-Baby Wellness, brings together community partners to provide wrap-around care to expectant and new moms with elevated scores for stress, anxiety and depression.

“When identified early, maternal stress is a modifiable risk factor that can be treated with psychotherapy, social support and other personalized, evidence-based interventions,” Dr. Limperopoulos said. “We look forward to continued research in this area to better understand the mechanisms behind these biological changes and the needs of mothers and children who are born during pandemics, natural disasters and other significantly stressful events.”

mother and baby doing a telehealth call

Using telehealth to study babies born to mothers infected with SARS-CoV-2

mother and baby doing a telehealth call

Continued advancements in telehealth methods to follow child neurodevelopment will help ensure robust child follow-up and inclusion of diverse cohorts.

Multiple studies have shown that SARS-CoV-2 infection can impact pregnant mothers and their fetuses but more research is needed to understand the long-term impact on the neurodevelopment of these children as they get older. Child neurodevelopmental evaluations are typically performed in-person. Since the COVID-19 pandemic began, the transition to telehealth methods was needed.

Continued advancements in telehealth methods to follow child neurodevelopment will help ensure robust child follow-up and inclusion of diverse cohorts, says a commentary in JAMA Network Open.

Why it matters

Commentary author Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National Hospital, highlights a new study that used a novel telehealth method to look for neurodevelopmental differences in infants ages 6-12 months born to mothers with SARS-CoV-2 infection compared to nonexposed infants of the same age and found no differences in neurodevelopment among the two cohorts. The study adapted a standardized assessment to a telehealth method.

“The results of this study provide needed reassurance to the many mothers who have experienced SARS-CoV-2 infection during pregnancy,” says Dr. Mulkey.

What’s been the hold up in the field?

“Developmental assessments that rely on observation of infants’ developmental skills can naturally make the transition to a telehealth platform,” says Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National Hospital and commentary author. “General movement assessment is an observation-based assessment of infants that can be captured by a parent or caregiver on video, and it has been used in neurodevelopmental outcomes studies of children after antenatal SARS-CoV-2 exposure.”

Moving the field forward

Child outcomes research can have improved enrollment and continuity of participant follow-up due to the availability of remote assessments. Neurodevelopmental tools are being developed that can be used on a telehealth platform or by parent recorded videos.

Researchers from the Children’s National Congenital Zika Virus Program have also developed telehealth-based methods for child outcome research that has been utilized in international Zika outcome studies funded by the Thrasher Research Fund and the NIH.

Read the full commentary, Use of Telehealth Methods to Track Infant Neurodevelopment After In Utero SARS-CoV-2 Exposure, in JAMA Network Open.

antibodies binding to coronavirus

Biomarker patterns unique to MIS-C and severe COVID in children identified

antibodies binding to coronavirus

Researchers have identified specific biomarker patterns in the blood that are unique to severe COVID-19 infection, as well as others unique to Multisystem Inflammatory Syndrome in Children (MIS-C).

Using powerful sequencing technology, researchers have identified specific biomarker patterns in the blood that are unique to severe COVID-19 infection, as well as others unique to Multisystem Inflammatory Syndrome in Children (MIS-C), a severe complication of COVID-19 infection in children. These findings pave the way for development of potential diagnostic tests in the future, according to a multi-center study published in Cell Reports Medicine. The study includes 416 blood samples from 237 patients at Children’s National Hospital, University of California at San Francisco and Emory University/Children’s Healthcare of Atlanta.

“Our overall goal is to develop tests that can accurately predict if a child with COVID is likely to develop severe disease, and also accurately distinguish children with MIS-C from children with other causes of fever,” says co-author Roberta DeBiasi, M.D., M.S., principal investigator of the study site at Children’s National and chief of the Division of Pediatric Infectious Diseases there. “These two groups of children can decompensate quickly and require rapid diagnosis and more aggressive treatments right from the beginning.”

MIS-C is a condition where different parts of the body, including skin, mucous membranes, gastrointestinal tract, heart, lungs, kidneys or brain can become inflamed after a COVID-19 infection. Researchers still don’t know why some children develop the condition and why minority children are over-represented in MIS-C cases.

The study is funded by National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development as part of a national effort to develop approaches to identify children at high risk of developing MIS-C.

The longitudinal analysis included 416 blood samples from 70 patients with acute COVID-19 (mild, moderate and severe illness) and 141 patients with MIS-C across the three hospitals. Blood samples included those that were collected at the beginning of the illness, during initial recovery, one-month after hospitalization and more than three months after illness.

Investigators used a combination of both whole blood RNA (wbRNA) sequencing, as well as cell-free RNA (cfRNA) and cell-free DNA (cfDNA) sequencing of plasma samples to identify key biosignatures. Information from wbRNA is primarily from circulating white blood cells and identifies inflammatory and immune responses to infection. In contrast, both cfRNA and cfDNA can inform about the levels and types of cell death from peripheral tissues.

“wbRNA analyses revealed that although multiple inflammatory pathways were activated in both severe COVID-19 and MIS-C, there were specific patterns that were unique to each disease and distinguish them from mild COVID and other control conditions,” says Meghan Delaney, D.O., M.P.H., co-author and co-investigator of the study at Children’s National. “This finding can be useful in understanding the pathogenesis of the diseases and also in developing a diagnostic test.”

Additionally, cfRNA and cfDNA analysis from MIS-C patients demonstrated distinct signatures of cell injury and death, including endothelial cells, which are the lining of blood vessels, and a type of neuronal cells called Schwann cells, indicating increased levels of organ injury compared to samples from COVID-19 patients.

“To our knowledge, no one has performed comprehensive analysis of both plasma cell-free RNA and whole blood RNA, as well as cell-free DNA in this setting, which is a powerful approach because it gives us different but complementary types of information,” says Dr. DeBiasi.

During the next three years of the four-year grant, researchers will continue working on developing a test that will accurately distinguish MIS-C from other inflammatory conditions affecting children such as Kawasaki Disease, as well as a test which can predict the likelihood of severe COVID-19 infection. Although this may be applied on a research basis in the near future, Dr. DeBiasi says it can take a period of months to years of regulatory reviews before such a diagnostic test could become available commercially.

baby getting vaccinated

Addressing COVID-19 vaccine hesitancy for parents and caregivers

 

baby getting vaccinated

A one-hour webinar delivered as a digital intervention can reduce parental COVID-19 vaccine hesitancy and parental uncertainty regarding vaccine information.

While vaccines have been proven to be highly effective in preventing COVID-19 infections and severe illness, the goal of achieving herd immunity remains unattainable without vaccinating children. Due to the prevalence of misinformation on the internet, Lauren Arrigoni, DNP, and Claire Boogaard, M.D., M.P.H., at Children’s National Hospital led a study, published in the Journal of Pediatric Health Care, that addresses parental hesitancy about giving their children COVID-19 vaccines. They found that a one-hour webinar delivered as a digital intervention can reduce parental COVID-19 vaccine hesitancy and parental uncertainty regarding vaccine information.

The big picture

The study used a pretest-posttest design with an adapted version of the Parental Attitudes about Childhood Vaccine (PACV) survey for COVID-19 vaccines. The webinar was streamed live and later posted to YouTube with survey QR codes and pre-survey and post-survey links in the video description. PACV data from the recorded webinar were collected over 4 weeks after the original webinar date. According to Dr. Arrigoni, the webinar itself was a collaborative work of a nurse and physicians to help provide scientific-based evidence for the general population of parents and caregivers. This project’s results have important implications for practice, as the researchers suggest that educational strategies have the potential to improve vaccination rates by increasing parental confidence in the COVID-19 vaccine. Using the webinar as a digital education strategy, the researchers also designed a dedicated section to empower parents to have conversations with their peers who may be hesitant about vaccines, even if they lack a medical background.

The patient benefit

While it was not possible to directly measure vaccination rates during this project due to time constraints, the researchers did find that parents who participated in the webinar felt more empowered and informed to make the decision to vaccinate their child. By addressing common parental concerns and providing accurate information, the webinar, as well as other types of digital interventions, could play a role in improving vaccination rates and ultimately contributing to truly ending the COVID-19 pandemic.

Why we’re excited

Overall, this study indicates that a webinar can effectively engage a large audience, educate them about vaccines and encourage conversations around vaccination.

“Vaccine hesitancy outreach can even begin before the vaccine is available,” says Dr. Arrigoni. “Applying these learned lessons can lead to more vaccinated individuals and would be an important step in battling parental vaccine hesitancy now and for future pandemics and viruses.”

You can read the full study, A Webinar to Improve Parental COVID-19 Vaccine Hesitancy, in the Journal of Pediatric Health Care.

coronavirus and DNA

Will SARS-CoV-2 during pregnancy impact child’s neurodevelopment?

coronavirus and DNA

Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National, will lead the neurodevelopmental evaluations of the infants born to mothers with SARS-CoV-2 infection during pregnancy to understand any long-term neurological effects in offspring.

Scientists led by the Lieber Institute for Brain Development are studying how a mother’s SARS-CoV-2 infection during pregnancy affects the biology of the placenta and the corresponding trajectory of the child’s brain development, including the risk for neurodevelopmental disorders such as schizophrenia and autism. The work is made possible by a $3 million, five-year grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, part of the National Institutes of Health.

The project stems from a collaboration between the Lieber Institute for Brain Development on the Johns Hopkins medical campus in Baltimore, Children’s National Hospital in Washington, D.C., and the Women’s Health Integrated Research Center at Inova Health System in Virginia.

The big picture

The group aims for a clearer picture of how a mother’s SARS-CoV-2 infection during pregnancy affects neurodevelopment in utero, the effects of which may manifest early in a child’s life. The researchers hope to understand how the infection interacts with other factors relevant to brain development, including genomic risk for neurodevelopmental disorders, maternal stress and social determinants of health.

The team will study whether the relationship between maternal SARS-CoV-2 infection and offspring brain development is mediated by changes in the biology of the placenta and the activation of the mother’s immune system. They will also gauge any differences in the effects of SARS-CoV-2 between female and male children and in the offspring of vaccinated and unvaccinated mothers.

Why it matters

Preliminary data show that pregnant people with symptomatic SARS-CoV-2 infections are more likely to have a preterm delivery, abnormalities in the placenta and prenatal and perinatal complications such as preeclampsia and fetal growth restriction. All these complications have been found to increase a child’s risk of neurodevelopmental disorders later in life.

What we hope to discover

Sarah Mulkey, M.D., prenatal-neonatal neurologist at Children’s National, will lead the neurodevelopmental evaluations of the infants born to mothers with SARS-CoV-2 infection during pregnancy to understand any long-term neurological effects in offspring. The researchers will evaluate the children’s neurodevelopment at both 24 and 36 months of age. This work builds upon Dr. Mulkey’s longitudinal neurodevelopmental evaluations in children exposed to Zika virus in utero.

“What we’ve learned is that even when babies don’t have Zika-virus-related birth defects, we still find differences in early child development compared to children who weren’t exposed to Zika virus,” said Dr. Mulkey. “With SARS-CoV-2, there is still so much we don’t know. But by better understanding the long-term impact of COVID exposure during pregnancy, we can ultimately find ways to prevent adverse outcomes.”

Abstract Happy 2022 New Year greeting card with light bulb

The best of 2022 from Innovation District

Abstract Happy 2022 New Year greeting card with light bulbA clinical trial testing a new drug to increase growth in children with short stature. The first ever high-intensity focused ultrasound procedure on a pediatric patient with neurofibromatosis. A low dose gene therapy vector that restores the ability of injured muscle fibers to repair. These were among the most popular articles we published on Innovation District in 2022. Read on for our full top 10 list.

1. Vosoritide shows promise for children with certain genetic growth disorders

Preliminary results from a phase II clinical trial at Children’s National Hospital showed that a new drug, vosoritide, can increase growth in children with certain growth disorders. This was the first clinical trial in the world testing vosoritide in children with certain genetic causes of short stature.
(2 min. read)

2. Children’s National uses HIFU to perform first ever non-invasive brain tumor procedure

Children’s National Hospital successfully performed the first ever high-intensity focused ultrasound (HIFU) non-invasive procedure on a pediatric patient with neurofibromatosis. This was the youngest patient to undergo HIFU treatment in the world.
(3 min. read)

3. Gene therapy offers potential long-term treatment for limb-girdle muscular dystrophy 2B

Using a single injection of a low dose gene therapy vector, researchers at Children’s National restored the ability of injured muscle fibers to repair in a way that reduced muscle degeneration and enhanced the functioning of the diseased muscle.
(3 min. read)

4. Catherine Bollard, M.D., M.B.Ch.B., selected to lead global Cancer Grand Challenges team

A world-class team of researchers co-led by Catherine Bollard, M.D., M.B.Ch.B., director of the Center for Cancer and Immunology Research at Children’s National, was selected to receive a $25m Cancer Grand Challenges award to tackle solid tumors in children.
(4 min. read)

5. New telehealth command center redefines hospital care

Children’s National opened a new telehealth command center that uses cutting-edge technology to keep continuous watch over children with critical heart disease. The center offers improved collaborative communication to better help predict and prevent major events, like cardiac arrest.
(2 min. read)

6. Monika Goyal, M.D., recognized as the first endowed chair of Women in Science and Health

Children’s National named Monika Goyal, M.D., M.S.C.E., associate chief of Emergency Medicine, as the first endowed chair of Women in Science and Health (WISH) for her outstanding contributions in biomedical research.
(2 min. read)

7. Brain tumor team performs first ever LIFU procedure on pediatric DIPG patient

A team at Children’s National performed the first treatment with sonodynamic therapy utilizing low intensity focused ultrasound (LIFU) and 5-aminolevulinic acid (5-ALA) medication on a pediatric patient. The treatment was done noninvasively through an intact skull.
(3 min. read)

8. COVID-19’s impact on pregnant women and their babies

In an editorial, Roberta L. DeBiasi, M.D., M.S., provided a comprehensive review of what is known about the harmful effects of SARS-CoV-2 infection in pregnant women themselves, the effects on their newborns, the negative impact on the placenta and what still is unknown amid the rapidly evolving field.
(2 min. read)

9. Staged surgical hybrid strategy changes outcome for baby born with HLHS

Doctors at Children’s National used a staged, hybrid cardiac surgical strategy to care for a patient who was born with hypoplastic left heart syndrome (HLHS) at 28-weeks-old. Hybrid heart procedures blend traditional surgery and a minimally invasive interventional, or catheter-based, procedure.
(4 min. read)

10. 2022: Pediatric colorectal and pelvic reconstructive surgery today

In a review article in Seminars in Pediatric Surgery, Marc Levitt, M.D., chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National, discussed the history of pediatric colorectal and pelvic reconstructive surgery and described the key advances that have improved patients’ lives.
(11 min. read)

coronavirus and DNA

Case study: COVID-19 patient with autoimmune adrenal insufficiency and hypothyroidism

coronavirus and DNA

This is the first report of a pediatric patient with COVID-19 who developed autoimmune thyroid and cortisol deficiency, although not confirmed that it was related or triggered by the COVID-19 infection.

There is emerging speculation that the inflammatory state associated with SARS-CoV-2 infection may trigger autoimmune conditions, but no causal link has been established. In a case study, published in Hormone Research in Paediatrics, researchers at Children’s National Hospital report a 14-year-old girl admitted with COVID-19 and symptoms of MIS-C who was then recognized to have autoimmune polyglandular syndrome (APS2). This is the first report of a pediatric patient with COVID-19 who developed autoimmune thyroid and cortisol deficiency, although not confirmed that it was related or triggered by the COVID-19 infection.

What this means

APS2 is rare in children and has an incidence of 1 in 20,000. Until now, there have only been reports of autoimmune thyroiditis and adrenal insufficiency in adults post-COVID-19.

“The role of COVID-19 in the etiopathogenesis of APS2 in this case remains unclear,” says Myrto Flokas, M.D., endocrinology fellow at Children’s National Hospital and first author of the case study. “But we suspect that it may have contributed to the rapid progression and severe clinical manifestations of both adrenal insufficiency and hypothyroidism leading to the presentation akin to MIS-C.”

The hold-up in the field

COVID-19 has been reported to affect the immune system and may serve as a trigger for autoimmune diseases similar to other viral infections.

“This is a case-report and while we cannot draw any mechanistic conclusions or infer causality, it is the first pediatric report of an association,” says Roopa Kanakatti Shankar, M.D., endocrinologist at Children’s National and one of the authors of the case study.  “We hope it will contribute to this novel field as our understanding of COVID-19 and its myriad effects on the immune system is still evolving.”

Why it matters

This case will alert clinicians to be mindful of the association and similarities in presentation of adrenal insufficiency to MIS-C and consider adrenal crisis in the differential diagnosis of such a presentation.

You can read the full case study, New-Onset Primary Adrenal Insufficiency and Autoimmune Hypothyroidism in a Pediatric Patient Presenting with MIS-C, in Hormone Research in Paediatrics.

pregnant woman

Early SARS-CoV-2 exposure may impact infant development

pregnant woman

The study found that some infants with in utero or early-life exposure to SARS-CoV-2 had borderline to low developmental screening scores.

Early SARS-CoV-2 exposure may impact neurodevelopment, especially among infants exposed in utero to symptomatic parents. This is according to a new study led by Sarah Mulkey, M.D., Ph.D., prenatal-neonatal neurologist in the Prenatal Pediatrics Institute at Children’s National Hospital. Dr. Mulkey and team conclude that vaccination and other precautions to reduce early-in-life infection may protect against neurodevelopmental delays. Children with early SARS-CoV-2 exposure should have additional long-term screening for neurodevelopmental delays.

Children’s National Hospital leads the way

The developing brain is vulnerable to both direct and indirect effects of infection during pregnancy and in the early neonatal period. To chart the impact of this exposure, the team created a clinical follow-up protocol in the Congenital Infection Program at Children’s National to chart the development of 34 infants exposed to SARS-CoV-2 in utero or in the neonatal period.

What we hoped to discover

“We conducted this study because we know that infants, when exposed to maternal COVID-19 infection in utero can be exposed to inflammation, fever and an abnormal intrauterine environment. SARS-CoV-2 can also affect the placenta, and in turn, the developing brain,” Dr. Mulkey shared with Healio.

This study aimed to determine if infants with early SARS-CoV-2 exposure developed abnormal neurodevelopment in infancy and the factors that may impact neurodevelopment differences. The study found that some infants with in utero or early-life exposure to SARS-CoV-2 had borderline to low developmental screening scores, most common among babies born to mothers with symptomatic COVID-19. Researchers followed the infants in their first months of life, gauging how the exposure affected their neurologic development. Results were demonstrated using a screening test called the Ages & Stages Questionnaires (ASQ), and those whose scores were borderline or low were most often born to mothers with symptomatic COVID-19.

Why it matters

In conducting this study, the team found that babies born during the pandemic, specifically under these conditions, do, in fact, require additional follow-up in the early stages of life. We may also see more differences in developmental outcomes as children get older.

“Any measure we can take to help prevent infections for mothers in their pregnancy can improve long-term developmental outcomes for children,” says Dr. Mulkey.

Other members of the Children’s National team that contributed to this work include Roberta L. DeBiasi, M.D., M.S.; Meagan E. Williams, M.S.P.H.; Nadia Jadeed, R.N.C.; Anqing Zhang, Ph.D.; and Smitha Israel, B.S.N.

Dr. Mulkey also published a recent article in the American Journal of Obstetrics & Gynecology that found the COVID-19 vaccine may protect pregnant women from SARS-CoV-2 placentitis and stillbirth. This work builds upon Dr. Mulkey’s longitudinal studies on Zika virus infection in pregnancy and long-term impacts on the child, funded by the Thrasher Research Fund and the National Institutes of Health.

pregnant woman getting vaccinated

COVID-19 vaccine may protect pregnant women from SARS-CoV-2 placentitis and stillbirth

pregnant woman getting vaccinated

In a new article published in the American Journal of Obstetrics & Gynecology, researchers conclude that the vaccine not only protects pregnant women but may also be lifesaving for their unborn children.

Stillbirth is a recognized complication of COVID-19 in pregnant women caused by harmful changes to the placenta induced by the virus. Termed SARS-CoV-2 placentitis, it can render the placenta incapable of providing oxygen to the fetus, leading to stillbirth and neonatal death. Researchers now suggest that pregnant women who get the COVID-19 vaccine may be protected from SARS-CoV-2 placentitis and stillbirth. In a new article published in the American Journal of Obstetrics & Gynecology, researchers conclude that the vaccine not only protects pregnant women but may also be lifesaving for their unborn children.

The extensive examination of published literature involved reviewing nearly 100 papers looking at COVID-19’s impacts on pregnant women and the effects on the placenta and pregnancy outcome. Sarah Mulkey, M.D., Ph.D., a prenatal-neonatal neurologist in the Division of Prenatal Pediatrics at Children’s National Hospital and co-author of the article, says the findings make a strong case for vaccination.

“The COVID-19 virus fortunately does not cause birth defects like other viruses such Zika, but it can cause severe injury to the placenta that can result in stillbirth and other pregnancy complications,” says Dr. Mulkey. “I hope patients who are pregnant or planning to become pregnant can learn how the COVID vaccine may help keep them and their baby healthy throughout pregnancy from some of the worst effects of this virus.”

While stillbirths can have many causes, the data analyzed supports that the COVID-19 vaccine is beneficial for pregnancies and for reducing the risk of stillbirth by reducing the risk of the virus impacting the placenta.

“In the multiple reports of SARS-CoV-2 placentitis that have been associated with stillbirths and neonatal deaths, none of the mothers had received COVID-19 vaccinations,” says David Schwartz, M.D., lead author, epidemiologist and perinatal pathologist. “And although not constituting proof, we’re not aware, either personally, via collegial networks, or in the published literature, of any cases of SARS-CoV-2 placentitis causing stillbirths among pregnant women having received the COVID-19 vaccine.”

Earlier in 2022, Dr. Schwartz led a team from 12 countries that found SARS-CoV-2 placentitis destroyed an average of 77.7% of placental tissue, resulting in placental insufficiency and fetal death, all occurring in unvaccinated mothers.

Fortunately, the large majority of pregnancies affected by a COVID-19 infection do not result in stillbirth. The development of SARS-CoV-2 placentitis is complex and likely involves both viral and immunological factors. The characteristics of a SARS-CoV-2 variant may also affect risk.

“Placental pathology is an important component in understanding the pathophysiology of SARS-CoV-2 infection during pregnancy,” says Dr. Mulkey.

As part of the Congenital Infection Program at Children’s National, Dr. Mulkey has been following infants born to mothers who had SARS-CoV-2 infection during pregnancy since the beginning of the pandemic. She will present the results of the early neurodevelopment of these infants at ID Week in Washington, D.C., on Oct. 22, 2022. Dr. Mulkey will also lead the neurodevelopmental follow-up of a large cohort of infants born to mothers with SARS-CoV-2 infection during pregnancy to better understand any long-term neurological effects to offspring.

The study builds upon Dr. Mulkey’s longitudinal studies on Zika virus infection in pregnancy and long-term impacts on the child that is funded by the Thrasher Research Fund.

lung ct scan

With COVID-19, artificial intelligence performs well to study diseased lungs

lung ct scan

New research shows that artificial intelligence can be rapidly designed to study the lung images of COVID-19 patients.

Artificial intelligence can be rapidly designed to study the lung images of COVID-19 patients, opening the door to the development of platforms that can provide more timely and patient-specific medical interventions during outbreaks, according to research published this month in Medical Image Analysis.

The findings come as part of a global test of AI’s power, called the COVID-19 Lung CT Lesion Segmentation Challenge 2020. More than 2,000 international teams came together to train the power of machine learning and imaging on COVID-19, led by researchers at Children’s National Hospital, AI tech giant NVIDIA and the National Institutes of Health (NIH).

The bottom line

Many of the competing AI platforms were successfully trained to analyze lung lesions in COVID-19 patients and measure acute issues including lung thickening, effusions and other clinical findings. Ten leaders were named in the competition, which ran between November and December 2020. The datasets included patients with a range of ages and disease severity.

Yet work remains before AI could be implemented in a clinical setting. The AI models performed comparably to radiologists when analyzing data similar to what the algorithms had already encountered. However, the AI was less valuable when trained on fresh data from other sources during the testing phase, indicating that systems may need to study larger and more diverse data sets to meet their full potential. This is a challenge with AI that has been noted by others too.

What they’re saying

“These are the first steps in learning how we can quickly and accurately train AI for clinical use,” said Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National, who led the Grand Challenge Initiative. “The global interest in COVID-19 gave us a groundbreaking opportunity to address a health crisis, and multidisciplinary teams can now focus that interest and energy on developing better tools and methods.”

Holger Roth, senior applied research scientist at NVIDIA, said the challenge gave researchers around the world a shared platform for developing and evaluating AI algorithms to quickly detect and quantify COVID lesions from lung CT images. “These models help researchers visualize and measure COVID-specific lesions of infected patients and can facilitate timelier and patient-specific medical interventions to better treat COVID,” he said.

Moving the field forward

The organizers see great potential for clinical use. In areas with limited resources, AI could help triage patients, guide the use of therapeutics or provide diagnoses when expensive testing is unavailable. AI-defined standardization in clinical trials could also uniformly measure the effects of the countermeasures used against the disease.

Linguraru and his colleagues recommend more challenges, like the lung segmentation challenge, to develop AI applications in biomedical spaces that can test the functionality of these platforms and harness their potential. Open-source AI algorithms and public curated data, such as those offered through the COVID-19 Lung CT Lesion Segmentation Challenge 2020, are valuable resources for the scientific and clinical communities to work together on advancing healthcare.

“The optimal treatment of COVID-19 and other diseases hinges on the ability of clinicians to understand disease throughout populations – in both adults and children,” Linguraru said. “We are making significant progress with AI, but we must walk before we can run.”

a quote from Joelle Simpson

Five leading children’s hospitals secure funding to enhance future pandemic readiness

a quote from Joelle Simpson A group of children’s hospitals from across the country will coordinate on the response to future pandemics and other disasters through a new $29 million grant from the Health Resources and Services Administration (HRSA). The group, known as the Pediatric Pandemic Network (PPN), will focus on the unique needs and challenges to children during pandemics and disasters, ensuring that health equity is at the forefront of emergency planning.

The five hospitals are:

  • Children’s National Hospital in Washington, D.C. (lead institution)
  • Ann & Robert H. Lurie Children’s Hospital of Chicago
  • University of Alabama at Birmingham Department of Pediatrics at Children’s of Alabama
  • Children’s Mercy Kansas City
  • Seattle Children’s

“As the current pandemic has proven to the world, pandemics and public health crises magnify pre-existing environmental, health, social and economic inequities,” said Joelle Simpson, M.D., M.P.H., principal investigator of this grant and division chief of Emergency Medicine and medical director of Emergency Preparedness at Children’s National. “Communities of color not only feel the impact of pandemics and disasters far more severely than others, but also have more difficulty obtaining aid and assistance. If the needs of vulnerable populations are not addressed in emergency planning, the national disaster preparedness strategy could fail for all.”

The hospitals recognize that while the COVID-19 pandemic has been devastating for the entire world, the pediatric population in particular has been challenged by a lack of established coordination among pediatric care providers. In addition to addressing health equity, the funding facilitates the following:

  • Establishing pathways to gather and disseminate research-informed insights into how to care for children in a future pandemic to both medical providers and community organizations.
  • Developing a telehealth infrastructure to support the care of acutely ill children and expand mental health access.
  • Expanding pediatric-focused emergency preparedness and planning with a focus on behavioral health, social support, and educational services, all of which are typically provided by community organizations.

The hub for this grant will be located at the newly opened Children’s National Research & Innovation Campus – the site of the former Walter Reed Army Medical Center in Washington, D.C. Work will take place in the renovated Armed Forces Institute of Pathology, where past investigators made seminal discoveries in infectious diseases and pandemics. The former campus was named after Walter Reed because of his work around discovering the cause and prevention of outbreaks of yellow fever. This modern-day team of physician researchers intends to make equally important contributions to future pandemics and other disasters to help preserve the health of our nation’s children.

In September 2021, HRSA launched the Regional PPN by funding five pediatric hospitals to support the planning and preparation of children’s hospitals to respond to a global health threat. This new grant doubles the size and reach of the network in order to benefit all children in the nation.

boy getting vaccinated

Adolescents with ADHD more hesitant to get COVID-19 vaccine

boy getting vaccinatedAdolescents with attention-deficit/hyperactivity disorder (ADHD) report greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD, a new study finds.

For all adolescents in the study, those who identified as Black or Latino — and came from families with lower income levels — were more likely to be vaccine hesitant and report lower confidence in the safety of COVID-19 vaccines.

Whereas greater COVID-19 concerns, compliance to social distancing guidelines, media use and perceived negative impact of COVID-19 on relationships was associated with greater vaccination willingness.

The study, led by Melissa Dvorsky, Ph.D., director of ADHD & Learning Differences Program at Children’s National Hospital, also highlighted that:

  • Adolescents with ADHD who engage in large gatherings indoors are at greater risk for vaccine hesitancy.
  • Interventions should target social-cognitive processes for adolescent vaccination.

“Adolescents with ADHD being more vaccine hesitant is perhaps in part due to core risk mechanisms associated with ADHD, likely impacting planning, motivation and execution of vaccination, adolescents’ risk appraisal, and perceived susceptibility to COVID-19,” Dr. Dvorsky said. “Our study also found key social mechanisms predicted increased vaccine acceptance and uptake, and these factors should be leveraged in ongoing initiatives addressing vaccine uptake among teens.”

Findings have important implications for health and mental health providers and educational strategies aimed at promoting COVID-19 vaccinations in adolescents.

Earlier this month, Mayor Muriel Bowser and DC Health announced amplified efforts to encourage families to vaccinate youth ahead of the upcoming 2022-2023 school year, sending a message that students must get caught up on vaccinations over the summer. In addition to expanding access to vaccination services, a concerted effort, Dvorsky added, is needed to increase trust, confidence, motivation and social relevance among adolescents. This is especially true for those with ADHD and from lower socio-economic backgrounds.

“As health and mental health care providers, we are uniquely positioned to offer effective communication using strong, presumptive language with all adolescents in our community to address vaccine hesitancy. Adolescents with ADHD, in particular, can benefit from frequent behavioral ‘nudges’ (such as prompts or reminders, automatic appointments) and social/motivational strategies (such as social network interventions, peer-delivered approaches, motivational interviewing) to increase vaccine uptake.”

It’s important to note that research addressing adolescent COVID-19 vaccination willingness and readiness remains scarce.

The study included 196 adolescents (87 male) ages 16-18 from two sites in the Southeastern and Midwestern United States. Participants were high school students in 11th and 12th grade during the 2020-2021 school year. Participants came from a range of socioeconomic backgrounds, with 21% of families falling below the 2019 U.S. median household income ($68,703). Approximately half of the participants were comprehensively diagnosed with ADHD prior to COVID-19.

Dr. Limperopoulos talks to a mom

Pandemic-related stressors in pregnant women affect fetal brain development

Dr. Limperopoulos talks to a mom

Dr. Catherine Limperopoulos walking with a mom.

Prolonged levels of stress and depression during the COVID-19 pandemic contributed to altering key features of fetal brain development — even if the mother was not infected by the virus. This is what a study published in Communications Medicine suggests after following more than 200 pregnant women. The study, led by Children’s National Hospital experts, emphasized the need for more scientific inquiry to shed light on the long-term neurodevelopmental consequences of their findings and COVID-19 exposures on fetal brain development.

“Understanding how contemporary stressors may influence fetal brain development during pregnancy has major implications for basic science and informing public policy initiatives,” said Catherine Limperopoulos, Ph.D., chief and director of the Developing Brain Institute at Children’s National and senior author of the study. “With this work, we are able to show there’s a problem, it’s happening prenatally, and we can use this model to start exploring how we can reduce stress in moms and support unborn babies.”

To better understand the effects of environmental exposures on the fetus during pregnancy, further confirmation of the team’s latest findings is needed by ruling out other possibilities, such as maternal nutrition, financial security and genetic factors.

The psychosocial impact of COVID-19 on fetal brain development remains vastly understudied. The neurologic underpinnings of fetal development that turn into psycho-behavioral disorders later in life, including bipolar disorder, mood disorder or anxiety disorder, remain complex and difficult to explain.

Among the 202 participants from the Washington D.C. metropolitan area, 137 were part of the pre-pandemic cohort and 65 were part of the pandemic cohort.

Through advanced MRI imaging techniques and reconstruction of high-resolution 3D brain models, the researchers found a reduction of fetal white matter, hippocampal and cerebellar volumes and delayed brain gyrification in COVID-19 pandemic-era pregnancies. Validated maternal stress, anxiety and depression scales were also used to compare the scores between the two cohorts.

This study builds upon previous work from the Developing Brain Institute led by Limperopoulos, which discovered that anxiety in pregnant women appears to affect the brain development of their babies. Her team also found that maternal mental health, even in high socioeconomic status, alters the structure and biochemistry of the developing fetal brain, emphasizing the importance of mental health support for pregnant women.

“We’re looking at modifiable conditions,” said Limperopoulos. “What’s clear is the next frontier is intervening early to see how we can prevent or reduce stress in the mom’s current setting.”

pregnant hispanic woman

COVID-19’s impact on pregnant women and their babies

pregnant hispanic woman

While pregnant women are at higher risk of severe illness, coronavirus can also trigger inflammatory and vascular responses in the placenta during critical periods of fetal development in symptomatic and asymptomatic cases.

Pregnant women should get vaccinated to minimize the detrimental health effects COVID-19 has on the placenta, the fetus and the newborn, states Roberta L. DeBiasi, M.D., M.S., division chief of Pediatric Infectious Diseases at Children’s National Hospital in an editorial published in The Journal of Infectious Diseases.

The editorial provides a comprehensive review of what is known about the harmful effects of SARS-CoV-2 infection in pregnant women themselves, the effects on their newborns, the negative impact on the placenta and what still is unknown amid the rapidly evolving field. The safety and efficacy of vaccination of pregnant women are also addressed.

While pregnant women are at higher risk of severe illness, the virus can also trigger inflammatory and vascular responses in the placenta during critical periods of fetal development in symptomatic and asymptomatic cases.

In this piece, Dr. DeBiasi comments on two related studies published in the same issue, Guan et al. and Shook et al., demonstrating pathologic findings in women’s placentas who had COVID-19 during pregnancy. Guan et al. published a detailed analysis of a stillbirth resulting from the delta variant infection during the third trimester.

“The authors present a highly plausible mechanism of stillbirth, namely that the virus-induced proinflammatory state ultimately led to placental abruption,” said Dr. DeBiasi.

Shook et al. presented a case series of pregnant women infected with the delta variant associated with stillbirth in two cases and one with severe neonatal illness.

“Taking the studies together, it’s evident that if a pregnant woman gets COVID-19 they’re at an increased risk of severe infection,” says DeBiasi. “They’re also at increased risk of adverse pregnancy outcomes, due to effects on the placenta, which may vary with specific circulating variants.”

Previous studies have documented that the placenta may be detrimentally affected by SARS-CoV-2 infection of the mother. However, maternal comorbidities such as hypertension, preeclampsia and gestational diabetes could also contribute to these findings.

“Despite these previous studies, the precise mechanisms of placental injury are still not clear and require further evaluation,” says Dr. DeBiasi. “Future research should include appropriate controls to better discern nonspecific versus SARS-CoV-2 specific effects and mechanisms of injury.”

Even though these potential risks exist, the vaccination rate among pregnant women is low. Dr. DeBiasi writes that recent publications have demonstrated vaccine efficacy and safety during pregnancy through programs that tracked the use in pregnant women. This data supports that COVID-19 vaccine offers another layer of protection to pregnant women since infants are not yet eligible for vaccination despite the fact that the youngest infants and children are among the most at risk among children for hospitalization.

doctor taking blood sample from child

Study shows increase in diabetes cases during COVID-19 pandemic

doctor taking blood sample from child

A retrospective study found pediatric Type 1 diabetes cases rose 15.2% and Type 2 diabetes cases increased by 182% during the first year of the COVID-19 pandemic compared to the prior two years— affecting non-Hispanic Black youth the most.

While the effects of COVID-19 on diabetes-related outcomes are extensively studied in adults, data about the incidence and severity of presentation of pediatric new-onset Type 1 diabetes (T1D) and Type 2 diabetes (T2D) is limited. A new retrospective study of 737 youth diagnosed with diabetes at Children’s National Hospital between March 11, 2018 and March 10, 2021 found pediatric T1D cases rose 15.2% and T2D cases increased by 182% during the first year of the COVID-19 pandemic compared to the prior two years — affecting non-Hispanic Black youth the most.

The study, published in Hormone Research in Paediatrics, compared T1D and T2D cases during the first 12 months of the pandemic, between March 11, 2020 and March 10, 2021, to the same time in the previous two years. This increase in cases was accompanied by a nearly six-fold rise in diabetic ketoacidosis (DKA) and a 9.2% incidence of hyperosmolar DKA during the pandemic as compared to no cases in the two years prior.

“A better understanding of the impact of the COVID-19 pandemic is crucial for raising public awareness, shaping policy and guiding appropriate health screenings,” said Brynn Marks, M.D., M.S.H.P.Ed., endocrinologist at Children’s National and lead author of the study.

Children’s National provides clinical care to approximately 1,800 youth with T1D and 600 youth with T2D annually. In the two years before the pandemic, cases of T2D accounted for 25.1% of all newly diagnosed diabetes at Children’s National compared to 43.7% during the pandemic. Before the pandemic, females accounted for 59.6% of youth with new-onset T2D but 58.9% of new-onset T2D cases were among males during the pandemic.

The researchers noted that the rise in cases of T2D and severity of presentation of both T1D and T2D during the pandemic disproportionately impacted non-Hispanic Black youth (NHB). NHB youth accounted for 58% of cases of T2D pre-pandemic, which further increased to 77% during the pandemic. The findings also showed that cases of DKA among NHB youth newly diagnosed with T1D increased during the pandemic compared to the two years before (62.7% vs. 45.8%, p=0.02).  Before the pandemic, there was no significant difference in A1c at T1D diagnosis between racial and ethnic groups. However, during the pandemic, hemoglobin A1c levels were higher among NHB youth.

“Future studies are needed to understand the root cause of the disproportionate impact of the COVID-19 pandemic on non-Hispanic Black youth with newly diagnosed diabetes,” said Dr. Marks. “These outcomes during the pandemic will likely worsen pre-existing health care disparities among youth with diabetes.  In understanding the indirect effects of our response to the pandemic, we can better inform future emergency responses and develop strategies to improve outcomes for all youth living with diabetes.”

boy getting covid test

Sentiments about COVID-19 testing among Black parents in the United States

boy getting covid test

An analysis led by Sarah Schaffer DeRoo, M.D., found that knowledge, attitudes and beliefs about COVID-19 testing plays a key role in preventing COVID-19 transmission among Black parents.

Black-majority communities have been disproportionately affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, hospitalizations and deaths. As of September 2021, Black Americans had nearly three times the hospitalization rate and double the death rate due to coronavirus disease 2019 (COVID-19), as compared to White Americans.

An analysis led by Sarah Schaffer DeRoo, M.D., pediatrician at Children’s National Hospital, aimed to characterize knowledge, attitudes and beliefs about COVID-19 testing – a key tool for preventing COVID-19 transmission – among Black parents.

Semi-structured interviews were conducted and analyzed using a phenomenology approach with 26 self-identified Black parents after telemedicine visits with a children’s health center. Three central themes emerged regarding COVID-19 testing decision-making, including perceived COVID-19 disease susceptibility, barriers to testing and cues to action. Parents were keen to pursue testing to ensure the safety of themselves and their loved ones, especially if they perceived a high risk for COVID-19 infection, such as due to a known positive contact. However, barriers to testing for some parents included concerns about accuracy and safety of the tests, as well as possible stigma associated with a positive test result. Parents also shared their concern that a positive test result would not be met with an appropriate medical response due to structural racism in the health care system, making some reluctant to pursue testing.

“When considering the themes that emerged from these interviews, we were able to better understand Black Americans’ views of COVID-19 testing and motivations for accessing testing,” says Dr. Schaffer DeRoo. “Culturally responsive educational campaigns delivered by trusted community members should aim to improve understanding about disease transmission and testing.”

Framing testing as a means to ensure safety and acknowledging and addressing institutionalized racism that affects COVID-19 care may improve self-efficacy to obtain testing. “The health community should learn from these conversations with Black Americans so that disease prevention and mitigation strategies prioritize health equity,” says Dr. Schaffer DeRoo.

sick child in palliative care hospital bed

New study compares first and second wave of MIS-C

sick child in palliative care hospital bed

When comparing the first and second wave of patients diagnosed with multi-system inflammatory syndrome in children (MIS-C), the second wave patients had more severe illness, according to a new prospective cohort study at Children’s National Hospital in Washington, D.C.

When comparing the first and second wave of patients diagnosed with multi-system inflammatory syndrome in children (MIS-C), the second wave patients had more severe illness, according to a new prospective cohort study of 106 patients at Children’s National Hospital in Washington, D.C. The results, published in The Pediatric Infectious Disease Journal, show that despite increased severity in the second wave cohort, both cohorts had similarities in cardiac outcomes and length of stay. Researchers are still working to better understand the exact immunologic mechanisms that trigger MIS-C and the specific factors accounting for its rare occurrence.

“We’ve now seen three distinct waves of MIS-C since the beginning of the pandemic, each wave following national spikes in cases,” said Roberta DeBiasi, M.D., chief of the Division of Pediatric Infectious Diseases at Children’s National and co-author of the study. “Kids in the second wave cohort had potentially experienced intermittent and/or repeated exposures to the virus circulating in their communities. In turn, this may have served as repeated triggers for their immune system which created the more severe inflammatory response.”

In this new study, key demographic features Children’s National researchers previously identified held true across both waves – including the fact that Black and Latino children are significantly more affected than white children.  Of the 106 patients, 54% were Black and 39% were Hispanic. The authors also noted that 75% of the patients were otherwise healthy children with no underlying medical conditions.

“While we believe the most recent third wave associated with the delta variant surge is tapering off, the findings from the first two waves provide important baseline information and are highly relevant for clinicians across the country that are evaluating and treating kids with MIS-C,” said Dr. DeBiasi.

Children’s National has cared for more than 4,200 symptomatic patients with SAR-CoV-2 infection and more than 185 MIS-C patients since the pandemic began. The first wave of MIS-C patients were hospitalized between March 2020 and October 2020. Second wave patients were hospitalized between November 2020 and April 2021. Each wave came 4-6 weeks following periods of COVID-19 surges in the community.

In the study, researchers compared patient demographics, clinical features, laboratory results, radiographic images, therapies and outcomes. The second wave cohort had a higher proportion of children 15 years of age or older. Patients also presented more frequently with shortness of breath and required more advanced respiratory and inotropic support. Researchers also found that patients in the second wave were less likely to test positive for SARS-CoV-2 on a PCR test.

Dr. DeBiasi and her team hope to unlock even more insights as they now analyze data from the third wave associated with the delta variant, which currently appears to have affected less children than the previous two. Children’s National is also working in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) to study the long-term effects of MIS-C and COVID-19 on the pediatric population after recovery. This is among the largest and longest studies being conducted, and researchers are hopeful the findings will help improve treatment of COVID-19 and MIS-C in the pediatric population both nationally and around the world.

“Our timely established multidisciplinary MIS-C task force here at Children’s National allowed us to reduce the learning curve,” said Ashraf S. Harahsheh, M.D., F.A.A.P., F.A.C.C., director of Quality Outcomes in Cardiology and co-first author of the study. “Experience from other centers showed that immunotherapy was utilized more frequently in recent MIS-C cohorts leading to reduction in percentage of cardiac complications. On the other hand, and despite having increased illness severity in the second cohort, our approach with prompt immunotherapy helped stabilize the rate of cardiac complications.”

group of teenagers sitting on a wall

Assessing the pandemic’s impact on adolescents with and without ADHD

group of teenagers sitting on a wall

Understanding factors that foster resilience and buffer against the negative psychological impact of COVID-19 is critical to inform efforts to promote adjustment, reduce risk and improve care, particularly for adolescents with neurodevelopmental disorders.

In a new prospective longitudinal study, Melissa Dvorsky, Ph.D., director of the ADHD & Learning Differences Program at Children’s National Hospital and lead author, and others address this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health and substance use, and by assessing specific positive coping strategies among adolescents with and without attention-deficit/hyperactivity disorder (ADHD).

Read the full study in Research on Child and Adolescent Psychopathology.

masked kids giving thumbs up in front of school bus

Pediatricians and public health officials should unite against controversial school masking bans

masked kids giving thumbs up in front of school bus

To keep in-person learning and protect students in schools, pediatricians and public health officials must advocate for evidence-based mitigation strategies that can reduce COVID-19 transmission — especially the Delta variant, which overwhelmed pediatric emergency rooms and hospitals, argued Yang et al. in a Perspective published in the journal Pediatrics.

To keep in-person learning and protect students in schools, pediatricians and public health officials must advocate for evidence-based mitigation strategies that can reduce COVID-19 transmission — especially the Delta variant, which overwhelmed pediatric emergency rooms and hospitals, argued Yang et al. in a Perspective published in the journal Pediatrics.

The authors propose that pediatricians and their associated institutions actively advocate for masking in schools and debunk myths and misinformation during well and sick visits. In addition, they encourage doctors to develop and disseminate behavioral strategies to support children’s compliance with masking based on individual abilities and needs. Finally, providers can partner with educators at the local, district, state and national levels to advocate for evidence-based masking policies.

“As pediatricians, it is our responsibility to advocate for universal masking to facilitate safe in-person schooling for all children,” said Sarah Schaffer DeRoo, M.D., pediatrician at Children’s National Hospital and co-author of the Perspective. “Children have readily adapted to masking during the pandemic and continuing this practice in schools is not a significant change from their recent experience.”

To date, nine states have enacted policies to prohibit school masking mandates, disregarding evidence that masking is a crucial COVID-19 preventive measure, Yang et al. wrote. The court overturned these mandates in four states out of the nine because they either exceeded the governor’s executive authority or did not comply with the law granting the executive order’s authority. In other instances, judges have only placed a temporary block.

“Despite politically charged rhetoric and headline-grabbing lawsuits, evidence shows that schools without mask mandates are more likely to have COVID-19 outbreaks,” said Y. Tony Yang, Sc.D., endowed professor of health policy and executive director of the Center for Health Policy and Media Engagement at the George Washington University, and lead author of the Perspective. “Pediatricians have generally commanded a heightened level of public trust, which suggests that pediatricians who make the case for policies that advance sound medical and public health science may have a greater chance than other advocates of generating the public and political will needed to make evidence-based policy ideas, such as school mask mandates, a reality.”

Some localities have found creative ways to circumvent state mask mandate bans by altering the school dress code to include face coverings and finding loopholes that do not apply to individual cities. Parents have also tried to challenge the policies in court, asserting that mask mandate bans violate federal anti-discrimination laws.

“Continued efforts are needed to ensure schools are able to promote reasonable, evidence-based strategies to promote the health of their students, teachers and communities, and we, as advocates for children, are obligated to emphatically support these efforts,” said Yang et al.