Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

Abstract

Background Very few studies describe factors associated with COVID-19 diagnosis in children. Aim We here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy. Methods We included cases aged 0–18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19. Results Among 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52–90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19–5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67–5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69–9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered. Conclusion Recommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.

Clinical, anamnestic, and sociodemographic predictors of positive SARS-CoV-2 testing in children: A cross sectional study in a tertiary hospital in Italy

“…Differently from other studies, we found an increased risk of a positive SARS-CoV-2 test in females (OR 1.49, 95%CI 1.0-2.3), and no association with citizenship (Italian vs foreign). In line with a large US report on 69,703 paediatric cases of COVID-19, systematic reviews and studies conducted in Italy, fever and cough were the most common symptoms [12,[17][18][19][20].…”

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

“…Prompt diagnosis of children infected with SARS-CoV-2 is not only important for individuals, but also essential to reduce the spread of the virus during the pandemic. 89 Abnormal results of COVID-19 laboratory tests in children are less common than in adults. 90 Cases of lymphopenia are very common in adults with COVID-19, while only 5.5% of children present with this test result.…”

Symptom clusters helping the assessment of SARS-COV-2-infected children: Amiens cohort versus European data

“…Furthermore, in our cohort, the more severe cases showed a common picture with a prevalence of symptoms belonging to respiratory and mucocutaneous-enteric clusters. This issue has been scarcely approached in literature [ 13 , 14 , 16 , 17 , 19 ] as, unfortunately, most authors did not stratify symptoms at presentation by illness categories.. However, although Aykac et al [ 14 ] and Arslan et al [ 13 ] did not focus on this issue in their articles, their data seem to suggest that symptoms coming from the “systemic mucocutaneous-enteric,” and the respiratory cluster occur in higher percentage in more severe cases, while loss of smell coming from the “neurological” cluster occurs more frequently in mild to moderate illness (except headache which is more represented in critical/severe cases).…”