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COVID-19 Return to Sports Participation for General Pediatricians and Recommendations for Cardiology Consultation after COVID-19

COVID-19 Return to Sports Participation for Primary Care and Recommendations for Cardiology Consultation after COVID-19

The following recommendations are based on published guidelines and medical literature, along with local expert consensus from the Division of Cardiology and Division of General Pediatrics.

For all COVID-19 positive patients, continue to follow CDC guidelines for isolation protocols.

Recommendations for Pediatric Patients with History of SARS-CoV-2 Infection

Note: Recommendations are subject to change based on the latest evidence and CHOP expert consensus, as more information about the cardiac manifestations of COVID-19 in our patients becomes available.

These guidelines were most recently updated in February 2023.

Asymptomatic Patients
and
Patients with Mild Symptoms
  • Asymptomatic: testing due to exposure, incidental finding of positive test, etc.
  • Mild symptoms (as defined by the AAP): 4 days of fever > 100.4°F
    and 1 week of myalgia, chills, or lethargy.
  • All patients, regardless of age, should refrain from sports until meeting the following criteria:
    • At least 5 days since the date of the positive SARS-CoV-2 test or symptom onset and
    • At least 24 hours without fever, while off of fever-reducing medications, and with improving symptoms and
    • No additional cardiac concerns or symptoms
  • Note: Although patients can return to activity after their quarantine duration ends, once they meet the above criteria, patients should continue to observe all current CDC protocols, including wearing a mask when around others for the full 10-day duration from the date of the positive SARS-CoV-2 test or symptom onset
  • Patients should be referred to outpatient cardiology for evaluation if there are any concerns for cardiac involvement, including any potential cardiac symptoms (e.g., chest pain, dyspnea on exertion, palpitations, syncope, etc.)
Patients with Moderate Symptoms
  • Moderate symptoms: This category will typically include patients with moderate symptoms who are managed at home with ≥ 4 days of fever
    100.4 °F or ≥ 1 week of myalgia, chills, or lethargy. However, this category can also apply to hospitalized patients who have only moderate symptoms who do not require an ICU admission
  • All patients, regardless of age, should refrain from sports until meeting the following criteria:
    • At least 10 days since the date of the positive SARS-CoV-2 test or symptom onset and
    • At least 24 hours without fever, while off of fever-reducing medications, and with improving symptoms and
    • No additional cardiac concerns or symptoms
  • Note: Previously, a screening ECG was recommended for patients ≥12 years old who had moderate symptoms, are involved in competitive sports, and had COVID-19 3 months ago. Given evidence demonstrating the lack of utility of screening ECGs in this context, this recommendation has been changed as of September 2021
  • We do not routinely recommend a screening ECG
  • Patients should be referred to outpatient cardiology for evaluation if there are any concerns for cardiac involvement, including any potential cardiac symptoms (e.g., chest pain, dyspnea on exertion, palpitations, syncope, etc.)
Patients with Severe Symptoms Requiring ICU Admission
  • All patients requiring ICU admission for severe acute COVID-19 symptoms should be restricted from sports and strenuous exercise for 3-6 months
  • Patients requiring ICU admission should be referred to outpatient cardiology for evaluation if they meet any of the following criteria:
    • Concern for cardiac involvement while inpatient or outpatient (e.g., cardiac symptoms, abnormal cardiac testing if obtained)
    • Patient participates in organized sports, strenuous exercise, and/or physical education program and thereby requires cardiac clearance to return to play (with anticipation that 3-6 months of sports restriction will be recommended)

For ALL patients who are cleared for return to sports/exercise

  • Whenever resuming activity (competitive sports, physical education class, recreational activities), patients should slowly advance activity and monitor for further symptoms  .
  • Any concern for clinical deterioration or cardiac symptoms should warrant further cardiac evaluation and discontinuation of sports/exercise until further notice.

Multisystem Inflammatory Syndrome in Children (MIS-C)

MIS-C is a severe inflammatory response that occurs in a subset of patients approximately 2-6 weeks after SARS-CoV-2 infection. Patients with MIS-C (regardless of severity) should be followed by pediatric cardiology outpatient with return to sports dictated by pediatric cardiology and often by a multidisciplinary team.

Refer to CHOP COVID-19 clinical pathways, including further information on evaluation and management of COVID-19 and MIS-C.

 

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