Cardiac screening prior to return to play after SARS-CoV-2 infection: focus on the child and adolescent athlete: A Clinical Consensus Statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology

Abstract Cardiac sequelae after COVID-19 have been described in athletes, prompting the need to establish a return-to-play (RTP) protocol to guarantee a safe return to sports practice. Sports participation is strongly associated with multiple short- and long-term health benefits in children and adolescents and plays a crucial role in counteracting the psychological and physical effects of the current pandemic. Therefore, RTP protocols should be balanced to promote safe sports practice, particularly after an asymptomatic SARS-CoV-2 infection that represents the common manifestation in children. The present consensus document aims to summarize the current evidence on the cardiac sequelae of COVID-19 in children and young athletes, providing key messages for conducting the RTP protocol in paediatric athletes to promote a safe sports practice during the COVID-19 era.

[1]  S. Ellermann-Eriksen,et al.  Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study , 2022, European Journal of Pediatrics.

[2]  M. C. Bisi,et al.  The impact of COVID-19 on physical activity behaviour in Italian primary school children: a comparison before and during pandemic considering gender differences , 2022, BMC Public Health.

[3]  M. Bonifazi,et al.  SARS-CoV-2 infection and return-to-play in junior competitive athletes: is systematic cardiac screening needed? , 2021, British Journal of Sports Medicine.

[4]  R. Thatcher,et al.  Impact of the COVID-19 Pandemic on Sedentary Time and Behaviour in Children and Adults: A Systematic Review and Meta-Analysis , 2021, International journal of environmental research and public health.

[5]  A. Samoylov,et al.  Graduated return to play guidance following COVID-19 infection , 2021, Sports medicine: research and practice.

[6]  J. Glickstein,et al.  Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents , 2021, Sports health.

[7]  M. Bonifazi,et al.  A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: Implications for a safe return-to-play , 2021, International Journal of Cardiology.

[8]  B. Maron,et al.  Return to Play for Athletes After COVID-19 Infection: The Fog Begins to Clear. , 2021, JAMA cardiology.

[9]  Kristie M. Harris,et al.  TELEHEALTH CARE BEFORE AND DURING COVID-19: TRENDS AND QUALITY IN A LARGE HEALTH SYSTEM , 2021, Journal of the American College of Cardiology.

[10]  M. Brzeziński,et al.  Physical activity, screen time and the COVID-19 school closures in Europe – An observational study in 10 countries , 2021, European journal of sport science.

[11]  L. Calò,et al.  Cardiovascular effects of COVID-19 lockdown in professional Football players. , 2021, Panminerva medica.

[12]  T. Grist,et al.  Evaluation for Myocarditis in Competitive Student Athletes Recovering From Coronavirus Disease 2019 With Cardiac Magnetic Resonance Imaging. , 2021, JAMA cardiology.

[13]  G. Parisi,et al.  COVID-19 Pneumonia in Children: From Etiology to Management , 2020, Frontiers in Pediatrics.

[14]  Simon M. Lin,et al.  Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States. , 2020, JAMA pediatrics.

[15]  M. Buman,et al.  World Health Organization 2020 guidelines on physical activity and sedentary behaviour , 2020, British Journal of Sports Medicine.

[16]  V. Palmieri,et al.  Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection? , 2020, British Journal of Sports Medicine.

[17]  F. Haddad,et al.  Cardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physicians , 2020, British Journal of Sports Medicine.

[18]  G. T. Gunnarsson,et al.  2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. , 2020, European heart journal.

[19]  J. Newburger,et al.  Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children. , 2020, Circulation.

[20]  Sijia He,et al.  A systematic review and meta‐analysis of children with coronavirus disease 2019 (COVID‐19) , 2020, Journal of medical virology.

[21]  Xanthi Andrianou,et al.  COVID-19 Disease Severity Risk Factors for Pediatric Patients in Italy , 2020, Pediatrics.

[22]  David R. Holtgrave,et al.  Multisystem Inflammatory Syndrome in Children in New York State , 2020, The New England journal of medicine.

[23]  Simon Li,et al.  Multisystem Inflammatory Syndrome in U.S. Children and Adolescents , 2020, The New England journal of medicine.

[24]  N. Heron,et al.  Infographic. Graduated return to play guidance following COVID-19 infection , 2020, British Journal of Sports Medicine.

[25]  H. Cokugras,et al.  SARS-CoV-2 infection in children , 2020, Turk pediatri arsivi.

[26]  B. Trogen,et al.  COVID-19-Associated Myocarditis in an Adolescent. , 2020, The Pediatric infectious disease journal.

[27]  M. Börjesson,et al.  Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC) , 2020, European journal of preventive cardiology.

[28]  Karsten M. Borgwardt,et al.  Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis , 2020, Travel Medicine and Infectious Disease.

[29]  L. Bonnemains,et al.  Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic , 2020, Circulation.

[30]  Jin Young Kim,et al.  COVID-19-related myocarditis in a 21-year-old female patient , 2020, European heart journal.

[31]  C. Eastin,et al.  Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China , 2020, The Journal of Emergency Medicine.

[32]  G. Wong,et al.  SARS-CoV-2 Infection in Children , 2020, The New England journal of medicine.

[33]  Ali Hasan,et al.  Coronavirus Disease (COVID-19) and Pediatric Patients: A Review of Epidemiology, Symptomatology, Laboratory and Imaging Results to Guide the Development of a Management Algorithm , 2020, Cureus.

[34]  Zhongyi Jiang,et al.  Epidemiology of COVID-19 Among Children in China , 2020, Pediatrics.

[35]  Mark Tomlinson,et al.  A future for the world's children? A WHO–UNICEF–Lancet Commission , 2020, The Lancet.

[36]  E. Howie,et al.  Promoting Physical Activity Through Youth Sports Programs: It’s Social , 2020, American journal of lifestyle medicine.