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Background The COVID-19 pandemic and associated public health measures have had a profound impact on health systems worldwide. The aim of this study was to assess quantitative and qualitative changes in Pediatric Emergency Department (PED) visits in Sardinia, Italy, during the early period of the COVID-19 pandemic. Methods We retrospectively investigated the number and characteristics of visits to two major Sardinian PEDs, in the periods January-June 2020 and January-June 2019. Results From January to June 2020, 8399 PED visits with 1160 hospital admissions (13.8% of PED visits) were registered, compared with 15,692 PED visits (Δ = -46.5%) and 1819 hospital admissions (11.6% of PED visits) occurring from January to June 2019. Comparing January-June 2020 with January-June 2019, we found differences in the percentage of visits for age groups, and significant changes in the proportion of triage codes, with a decrease in green codes (72.1% vs 74.2%, respectively) and an increase in white codes (19.0% vs 16.5%, respectively). Moreover, in the period January-June 2020, the frequency of skin disorders and acute respiratory disease significantly decreased, while the frequency of trauma, acute surgical disease, intoxication, and neuropsychiatric disease significantly increased. Conclusions After the beginning of the Italian lockdown, we observed a marked drop in the number of PED visits, an increase in hospital admission rate, and radical changes in the reason for visit.

Background: covid19 infection, in children compared to adults, often occurs in a pauci and/or asymptomatic manner, but in some cases, a multisystem inflammatory syndrome (MIS) may occur in the 4-6 weeks following the infection. There are few data on the features of MIS after the clinical recovery phase, therefore we have described three cases of children with post-covid19 infection syndrome. Case presentation: out of the three cases described, in two children the onset clinical symptoms were similar to Kawasaki syndrome, while in the other neurological impairment was prevalent. In none of the three there were gastrointestinal symptoms, while the signs of interstitial disease were constant on lung ultrasound. In all of them, there was an increase in the inflammatory markers, high levels of ferritin, lymphocytopenia and thrombocytopenia only in one case. The lipid profile at onset was characterized by an increase in triglyceride levels. In all cases the course was benign with resolution of the symptoms upon admission within 4-5 days. After 1 month from the clinical recovery phase, the patients showed normalization of cytokines, inflammatory markers and triglyceride levels, while the total cholesterol value increased. Covid19 infection leads to an acute phase response with increase of the triglyceride in addition to inflammatory markers and the signs of interstitial disease on lung ultrasound. Conclusions: the inflammatory markers and lung involvement normalize over 30 days, while an initial increase of the triglyceride - and later in total cholesterol - suggest a direct relationship between triglyceride and inflammatory markers at the beginning, and between total cholesterol and host immune response during the follow-up.