International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward

BACKGROUND

Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care.

METHODS

We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care.

RESULTS

Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support.

CONCLUSIONS

We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration.

IMPACT

Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.

Kinetics of the reaction of S-carboxymethyl-L-cysteine with palladium(II) chloride

The influence of the acidity and the Cl- concentration on the kinetics of the complex formation between s-carboxymethyl-L-cysteine and Pd(II) chloride was studied with a stopped-flow technique in the pH range from 1.5 to 5.0 at 25 degrees C. The reaction mechanism involving Pd(H2O)4-nCln, LH-, LH2 and LH3+ species was proposed. Fairly good agreement between the computed and experimentally determined rate constants was found.

Use of palladium(II) chloride as a colour-forming reagent for the determination of N-acetyl-L-cysteine in water and fluimukan injections

The formation of the complex between N-acetyl-L-cysteine and palladium(II) chloride in Britton-Robinson buffer solution in the pH range 2.08-8.00 was studied. The optimum conditions for this reaction were ascertained and a spectrophotometric method was developed for the determination of N-acetyl-L-cysteine in the concentration range 4.0-65.3 micrograms ml-1, using PdCl2 as the reagent. The detection limit was 1.63 micrograms ml-1 and the relative standard deviation varied from 0.63 to 1.92%. The method was applied to the determination of N-acetyl-L-cysteine in water and in injection solutions.