Clinical presentation of pediatric patients with symptomatic SARS-CoV-2 infection during the first months of the COVID-19 pandemic in a single center in Mexico City

Abstract

BackgroundThe clinical spectrum of COVID-19 is broad, from asymptomatic to severe cases and death. The objective of this study is to analyze the clinical course of patients attended during the first months of the SARS-CoV-2 pandemic in a third-level pediatric hospital.MethodsDesign: prospective cohort study. Patients with viral respiratory disease or suspected cases of COVID-19 were evaluated at the Pediatric Hospital, National Medical Center XXI Century, Mexico City, from 21 March 2020 to 13 January 2021. Statistical analysis: Chi-square test and Fisher’s exact test were used for comparisons; a logistic regression model was constructed to identify clinical or laboratory characteristics associated with critical disease. A p-value < 0.05 was considered statistically significant.ResultsA total of 697 patients met the operational definition of viral respiratory disease or suspected cases of COVID-19 and underwent real-time reverse transcription polymerase chain reaction (rRT-PCR) SARS-CoV-2 testing. Patients with a positive result were included. Of the 181 patients (26%), 121 (66.8%) had mild disease and were treated as outpatients and 60 (33.1%) were hospitalized. A total of six patients met the criteria for multisystem inflammatory syndrome in children (MIS-C). Of the 60 inpatients, 65% were males, and 82% had one or more comorbidities. The main comorbidities were cancer (42%) and overweight (15%). The median hospital stay was 9 days. The inpatients had a higher frequency of fever, general malaise, dyspnea, chills, polypnea, and cyanosis than the outpatients (p < 0.05). Only 21.4% of the outpatients had one or more comorbidities, which were lower than in the hospitalized patients (p < 0.001). Laboratory data at admission were similar between critically ill and those with moderate and severe disease. The patients who developed pneumonia were at higher risk of critical disease, while older age was associated with a better prognosis. A total of 13 of the 60 inpatients died (mortality 7.1%). All but one had one or more comorbidities: four had cancer, four congenital heart disease, one chronic kidney disease and epilepsy, one Epstein–Barr virus-induced hemophagocytic lymphohistiocytosis, one obesity, and one diabetes mellitus.ConclusionHospital mortality is high, especially in children with comorbidities. Despite 2 years having passed since the beginning of the COVID-19 pandemic, the epidemiological and clinical data on children are still helpful to improve their prognosis.

Clinical and laboratory characteristics of multisystem inflammatory syndrome in children associated with COVID‐19 in Egypt: A tertiary care hospital experience

“…The mortality rate of our patients was higher than that reported in high‐income countries, including multicentre studies (3–9%) 29–31 . It was also higher than that reported in India (10%), Turkey (6.9%) and Mexico City (7.1%) 15,16,23 . In addition, there were no reported deaths among hospitalised children with MIS‐C in Cape Town, South Africa, according to Butters et al 24 …”

“…[29][30][31] It was also higher than that reported in India (10%), Turkey (6.9%) and Mexico City (7.1%). 15,16,23 In addition, there were no reported deaths among hospitalised children with MIS-C in Cape Town, South Africa, according to Butters et al 24 The increased mortality rate observed in our study could be attributed to the following factors: first, the majority of these patients were referred from other health-care facilities and had a serious spectrum of illnesses at the time of enrolment (64.4% had respiratory manifestations, 48.9% had coma, 44.4% had shock, 33.3% had seizures, 22.2% had cerebrovascular stroke, 26.7% had evidence of myocarditis, 6.7% had recent dilated cardiomyopathy, 2.2% had coronary artery aneurysm and 2.2% had pericardial effusion); second, asymptomatic cases and patients with mild clinical manifestations who could be treated in primary care were not included in this study; third, the mortality rate in our study could have been reduced if we had used ECMO, which is not currently available at our hospital; and fourth, patients with MIS-C overlapping severe acute COVID-19 had evidence of respiratory involvement, as our study results showed, and the majority of these children had a positive PCR for SARS-CoV-2 with negative serology, and their mortality rate was higher. We hypothesise that early identification of patients and the availability of resources are critical for timely health-care delivery.…”

“…More data are required to understand the differences in MIS‐C burden, severity and outcomes in lower‐middle‐income countries (LMIC), as it is important to consider the regional, genetic and ethnic distributions of children with MIS‐C to establish the best diagnostic criteria and treatment recommendations 10,15,23–26 . In addition, published literature from Egypt regarding MIS‐C associated with COVID‐19 in hospital settings is limited.…”

“…22 More data are required to understand the differences in MIS-C burden, severity and outcomes in lower-middle-income countries (LMIC), as it is important to consider the regional, genetic and ethnic distributions of children with MIS-C to establish the best diagnostic criteria and treatment recommendations. 10,15,[23][24][25][26] In addition, published literature from Egypt regarding MIS-C associated with COVID-19 in hospital settings is limited. Therefore, the current study characterised the clinical manifestations, laboratory test results and mortality outcomes of 45 children who met the CDC criteria for MIS-C associated with COVID-19 at a tertiary care hospital in Egypt.…”

Clinical characteristics of pediatric patients with confirmed SARS-CoV-2 infection who followed rigorous measures during two years of the COVID-19 pandemic in a hospital in Mexico

“…Children and adolescents are less likely to develop severe COVID-19 manifestations. Previous studies mentioned that patients with underlying medical conditions are more susceptible to severe illness with higher hospitalization and mortality rates ( 13 , 23 , 26 , 32 ). In a cross-sectional study on 43,465 pediatric patients with COVID-19 by Kompaniyets et al, the significant risk factors for hospitalization were type 1 diabetes and obesity.…”