http://www.ncbi.nlm.nih.gov/pubmed/32873575?tool=bestpractice.com Increasing interleukin-6 levels correlate with increasing fibrinogen levels. Stillbirths during the COVID-19 pandemic in England, April-June 2020. Pakpour S, Scott JA, Turvey SE, Brook JR, Takaro TK, Sears MR, et al. Gastroenterology. Predicting the atopic march: Results from the Canadian Healthy Infant Longitudinal Development Study. [887]Ruan Q, Yang K, Wang W, et al. However, most studies included minor symptoms such as headache and dizziness, which are classified as symptoms of COVID-19 in this topic rather than complications. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext http://www.ncbi.nlm.nih.gov/pubmed/32639420?tool=bestpractice.com, Risk factors associated with severe liver injury include older age, pre-existing liver disease, and severe COVID-19. https://covid19treatmentguidelines.nih.gov/ Song JC, Wang G, Zhang W, et al. Sex-specific impact of asthma during pregnancy on infant gut microbiota. In a survey study of symptomatic adults, 35% had not returned to their usual state of health 2 to 3 weeks after testing. Among women who are significantly obese, about 50 percent of them must undergo Caesarean sections, compared to only about 20 percent of the general population. Breastfeeding and the Developmental Origins of Asthma: Current Evidence, Possible Mechanisms, and Future Research Priorities. 2020 Aug 18 [Epub ahead of print]. The first report of a successful pregnancy in cystic fibrosis (CF) was in 1960. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. https://www.thelancet.com/pdfs/journals/lanhae/PIIS2352-3026(20)30145-9.pdf Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Early reports suggest that COVID-19 patients treated in the intensive care unit can present with post-intensive care syndrome, a spectrum of psychiatric, cognitive, and/or physical disability (e.g., muscle weakness, cognitive dysfunction, insomnia, depression, anxiety, post-traumatic stress disorder, delirium, encephalopathy) that affects survivors of critical illness, and persists after the patient has been discharged from the intensive care unit. Time of stroke onset in coronavirus disease 2019 patients around the globe: a systematic review and analysis. Circulation. Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19. Mycoses. https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm Management of post-acute covid-19 in primary care. http://www.ncbi.nlm.nih.gov/pubmed/32374029?tool=bestpractice.com http://www.ncbi.nlm.nih.gov/pubmed/33120956?tool=bestpractice.com https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.046941 https://www.nejm.org/doi/full/10.1056/NEJMc2007575, http://www.ncbi.nlm.nih.gov/pubmed/32268022?tool=bestpractice.com. Inflammation in the myocardium can result in myocarditis, heart failure, arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. J Thromb Thrombolysis. 2020 [internet publication]. Hua A, O'Gallagher K, Sado D, et al. https://www.bmj.com/content/368/bmj.m1091.long http://www.ncbi.nlm.nih.gov/pubmed/32307014?tool=bestpractice.com, Standard guidance for the management of bleeding manifestations associated with DIC or septic coagulopathy should be followed if bleeding occurs; however, bleeding manifestations without other associated factors is rare. Simard M, Madore AM, Girard S, Waserman S, Duan Q, Subbarao P, et al. Pediatrics. http://www.ncbi.nlm.nih.gov/pubmed/32171190?tool=bestpractice.com https://onlinelibrary.wiley.com/doi/10.1002/art.41454, http://www.ncbi.nlm.nih.gov/pubmed/32705809?tool=bestpractice.com. Home. 2018 Sep 17; 190(37): E1097–E1107. Kubota T, Kuroda N. Exacerbation of neurological symptoms and COVID-19 severity in patients with preexisting neurological disorders and COVID-19: a systematic review. 2020 Apr 23;382(17):e38. JAMA. 2020 Apr 23;382(17):e38. Takotsubo syndrome in patients with COVID-19: a systematic review of published cases. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. Gut Microbes. Sleep. Front. Pediatrics. Moores LK, Tritschler T, Brosnahan S, et al. Microbes Infect 2016;18:543-9. 2020 Aug 17 [Epub ahead of print]. Your feedback has been submitted successfully. Drall KM, Field CJ, Haqq AM, de Souza RJ, Tun HM, Morales-Lizcano NP, et al. The pathogenesis and treatment of the `'cytokine storm' in COVID-19. https://www.cdc.gov/mmwr/volumes/69/wr/mm6940e1.htm Another study in the UK found that nearly 75% of patients who are discharged from hospital remain symptomatic at 3 months. Diagnosing COVID-19-associated pulmonary aspergillosis. The science underlying COVID-19: implications for the cardiovascular system. Heart Rhythm. http://www.ncbi.nlm.nih.gov/pubmed/31986264?tool=bestpractice.com https://thorax.bmj.com/content/early/2020/12/02/thoraxjnl-2020-216377 Tailor monitoring to the patient’s symptoms, and consider supported self-monitoring at home (e.g., heart rate, blood pressure, pulse oximetry). In patients with heparin-induced thrombocytopenia (or a history of it), argatroban or bivalirudin are recommended. In 2010, smoking during pregnancy was highest among American Indian women (26.0%), followed by non-Hispanic white women (14.3%), non-Hispanic Black … Persistent symptoms in patients after acute COVID-19. Pregnancy per se increases the incidence (8.1%) of OSA because of the augmented neck circumference, the reduced nasal patency and the pharyngeal oedema. J Clin Invest. [1018]Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. 2020 Mar 26;368:m1091. The presence of these antibodies can rarely lead to thrombotic events in some patients (especially those who are genetically predisposed) that are difficult to differentiate from other causes of multifocal thrombosis. [1051]Verweij PE, Gangneux JP, Bassetti M, et al. http://www.ncbi.nlm.nih.gov/pubmed/32368701?tool=bestpractice.com Complications include arrhythmias or palpitations (18.4%), myocardial injury (10.3%), angina (10.2%), acute myocardial infarction (3.5%), and acute heart failure (2%). 2020 Mar 13:101623. 2020 Feb 7;323(11):1061-9. [376]World Health Organization. Pathology Subtypes. Concern exists among care providers about the impact of pregnancy on the health of women with CF. The review of five papers by Schwartz examined 39 newborns from 38 pregnant women in China, and all of 30 women tested for COVID-19 was found negative. JAMA Cardiol. http://www.ncbi.nlm.nih.gov/pubmed/32073213?tool=bestpractice.com, Coagulopathy manifests as elevated fibrinogen, elevated D-dimer, and minimal change in prothrombin time, partial thromboplastin time, and platelet count in the early stages of infection. http://www.ncbi.nlm.nih.gov/pubmed/32179124?tool=bestpractice.com, Guidelines for the management of shock in critically ill patients with COVID-19 recommend a conservative fluid strategy (crystalloids preferred over colloids) and a vasoactive agent. http://www.ncbi.nlm.nih.gov/pubmed/32374815?tool=bestpractice.com [990]Farkash EA, Wilson AM, Jentzen JM. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext 2021 Jan 11 [Epub ahead of print]. https://onlinelibrary.wiley.com/doi/abs/10.1002/art.41425, http://www.ncbi.nlm.nih.gov/pubmed/32602200?tool=bestpractice.com. Huang C, Wang Y, Li X, et al. These complications can occur on presentation or develop as the severity of illness worsens. http://www.ncbi.nlm.nih.gov/pubmed/32553126?tool=bestpractice.com, Can develop at any time before or during hospital admission. Factors associated with the development of myocardial injury include older age, male sex, and the presence of comorbidities. Paediatr Perinat Epidemiol. Hammam N, Sadeghi D, Carson V, Tamana SK, Ezeugwu VE, Chikuma J, et al. https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14854 A rare, but severe condition, reported in children and adolescents approximately 2 to 4 weeks after the onset of COVID-19, likely due to a post-infectious inflammatory process. Neurol Sci. The incidence of acute hepatic injury was higher in Chinese populations and groups with a higher prevalence of pre-existing chronic liver disease; the incidence was similar in younger and older patients. 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Median time from onset of COVID-19 symptoms to stroke was 8 days. external link opens in a new window Perform a urinalysis for blood, protein, and glucose to help identify the underlying cause. 2020 Sep 18 [Epub ahead of print]. Regional caesarean delivery practices, the maternal-infant microbiome, and risk for asthma. 2020 May 11;7(6):e438-40. Gastroenterology. Pregnant women are more likely to need intensive care unit admission and invasive ventilation, especially those with a pre-existing comorbidity. JAMA. https://www.nice.org.uk/guidance/ng188 EClinicalMedicine. https://thorax.bmj.com/content/early/2020/11/09/thoraxjnl-2020-215818, http://www.ncbi.nlm.nih.gov/pubmed/33172844?tool=bestpractice.com. Circulation. 2011; 119: 591-7. 2020 May 6 [Epub ahead of print]. Coagulation abnormalities and thrombosis in patients with COVID-19. J Sci Med Sport 2019; Jan 10. pii: S1440-2440(18)31027-2. https://wwwnc.cdc.gov/eid/article/26/7/20-1603_article, http://www.ncbi.nlm.nih.gov/pubmed/32343223?tool=bestpractice.com. Description and proposed management of the acute COVID-19 cardiovascular syndrome. J Thromb Haemost. Thorax. Guidance on the diagnosis and management of COVID-19-associated pulmonary aspergillosis has been published. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). SN Compr Clin Med. J Trop Pediatr. 2020 Jul 9 [Epub ahead of print]. 2020 Jul 1;105(7):dgaa276. http://www.ncbi.nlm.nih.gov/pubmed/32705809?tool=bestpractice.com, While an association between this syndrome and COVID-19 seems plausible based on current evidence, the association is not definitive and further research is required. 2020;371:m3513 [Citation ends]. 2020 Apr 19 [Epub ahead of print]. Coronavirus disease 2019 (COVID-19) treatment guidelines. 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During pregnancy, outpatient visits were 33% more frequent compared to baseline and 62% more frequent than in the nonpregnant group (7.19 vs 4.45, respectively, visits annually). Most patients have fever, as well as features of shock, cardiac involvement (e.g., elevated cardiac markers, congestive heart failure, cardiac dysfunction, myocarditis, coronary artery dilatation or aneurysm, hypotension, pericardial effusion, mitral regurgitation), gastrointestinal symptoms (e.g., abdominal pain, vomiting, diarrhoea), and significantly elevated inflammatory markers. International Journal of Obesesity (Lond). Wang J, Yang Q, Zhang P, et al. 2020;370:m3026 [Citation ends]. Patients with very high D-dimer levels have the greatest risk of thrombosis and may benefit from active monitoring. Canadian Medical Association Journal. JAMA. COVID-19 and its implications for thrombosis and anticoagulation. 2020 Apr 28;26(7). 2020 Nov 9 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239617/ [3]National Institutes of Health. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. European Medicines Agency. Risk factors included older age, male sex, presence of comorbidities, and admission to a hospital with a smaller number of intensive care unit beds. [47]Chen N, Zhou M, Dong X, et al. http://www.ncbi.nlm.nih.gov/pubmed/32784198?tool=bestpractice.com These studies highlight the importance of having a high suspicion for venous thromboembolism in patients who have signs of coagulopathy, including elevated D-dimer level. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. Around 9% of patients had deteriorating chest x-ray appearances at follow-up, which may indicate lung fibrosis. 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These guidelines were developed by consensus based on expert opinion and a review of the medical literature. 2020 [internet publication]. 2020 Jun 4;135(23):2033-40. Zulyniak MA, de Souza RJ, Shaikh M for the NutriGen Alliance investigators, et al Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? http://www.ncbi.nlm.nih.gov/pubmed/32785632?tool=bestpractice.com. Liu PP, Blet A, Smyth D, et al. [992]Gross O, Moerer O, Weber M, et al. http://www.ncbi.nlm.nih.gov/pubmed/32992196?tool=bestpractice.com Lancet. SARS-CoV-2-related atypical thyroiditis. BMJ. https://covid19treatmentguidelines.nih.gov/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158946/, http://www.ncbi.nlm.nih.gov/pubmed/32278361?tool=bestpractice.com. In vivo immune signatures of healthy human pregnancy: inherently inflammatory or anti-inflammatory?. Crit Care. Parks J, McCandless L, Dharma C, Brook J, Turvey SE, Mandhane P, et al. Sbihi H, Jones MJ, MacIsaac JL, Brauer M, Allen RW, Sears MR, et al. http://www.ncbi.nlm.nih.gov/pubmed/32838230?tool=bestpractice.com https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501509/ SARS-CoV-2: a storm is raging. Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2: a systematic review. http://www.ncbi.nlm.nih.gov/pubmed/33172719?tool=bestpractice.com, Patients may show cerebral changes on magnetic resonance imaging months after recovery, suggesting that long-term consequences may be possible. 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