Clinical spectrum and risk factors for complicated disease course in children admitted with SARS-CoV-2 infection

Abstract

Introduction At this time there are still major questions about the characteristics of disease caused by the new coronavirus (COVID-19) in children as well as factors associated with the development of severe forms of the disease. Study design Retrospective study including patients under 18 years of age admitted with SARS-CoV-2 infection from March 1 to April 30, 2020. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or antibody testing. We describe the epidemiological and clinical data, laboratory and imaging findings, as well as treatment and outcome in these patients. In light of these findings, patients were classified into two severity groups and then compared. Results Thirty-nine children were included, with a median age of 9 years (range 12 days–16 years); 23 were boys. Cases with uncomplicated disease course (24) mostly presented to the emergency department (ED) with fever and/or respiratory symptoms without significant alterations in laboratory findings. Of the 15 children with a complicated course, 12 developed shock. In addition to fever, they frequently presented altered appearance, extreme tachycardia, abdominal pain, vomiting, diarrhea, rash, and/or conjunctival hyperemia. They also showed greater lymphopenia ( p = 0.001), elevated neutrophil/lymphocyte ratio ( p = 0.001), C-reactive protein ( p < 0.001), procalcitonin ( p = 0.001), D-dimer ( p < 0.001), and ferritin ( p < 0.001). Conclusions SARS-CoV-2 infection in admitted children presents with great clinical variability. When provided supportive care, patients with predominant respiratory symptoms without altered laboratory-test results generally have an uncomplicated course. Patients with complicated disease present mainly with fever and abdominal and/or mucocutaneous symptoms. Most develop shock. Elevation of inflammatory markers may allow for early detection and the final outcome is good.

SARS-CoV-2 Infection: Differences in Hematological Parameters Between Adults and Children

“…In addition, are the NLR different between children with COVID-19 and adults? A retrospective study analyzed the clinical manifestations and laboratory examinations of 39 patients with COVID-19 under the age of 18, and found that there were no significant changes in the laboratory examinations of patients in ordinary cases, but the NLR was significantly increased in severe children, 48 which is consistent with adult’s data. Garcia-Salido conducted a statistical analysis of children with multiple system inflammatory syndrome secondary to COVID-19 (MIS-C), the neutrophils and NLR in the MIS-C group were both higher than non-MIS-C group.…”

“… 74 , 75 Due to decreased fibrinolysis and elevated D-dimers, thrombus may be formed in the body, even resulting in DIC to happen, and then, the condition of patients will deteriorate soon. 76 In severe cases or death cases, the level of D-dimer is significantly higher than that of other patients, and the content of fibrinogen is significantly reduced, and there are statistics scientific significance, 23 , 29 , 48 where D-dimer greater than 1000μg/L is considered to be related to poor prognosis. 10 The rate of COVID-19 suffered by DIC has been reported as 71.4% for deaths.…”

Expectations of Patients Seen in the Emergency Department for SARS-CoV-2 During the Pandemic

“…This lack of concern may be attributable to the fact that the symptomatology of the children was similar to that associated with many benign viral processes that are no cause for alarm and are by no means exclusive to infection by SARS-CoV-2. Therefore, the expectations of the caregivers may be seen as appropriate, in that it was subsequently demonstrated that infection by SARS-CoV-2 is infrequent and generally benign in the pediatric population 6,7,[11][12][13][14] ; in fact, in another study carried out in our hospital, of 960 patients visiting the PED with fever and/or respiratory symptoms, only 6% were confirmed as having the illness. 14 Apart from the limitations inherent in studies based on surveys, the voluntary nature of participation in the study carried the risk of sample bias.…”

Paediatric asthma exacerbation admissions and stringency of non‐pharmaceutical interventions: Results from a developing country

“…Late 2019, the globe witnessed the emergence of a new strain of the coronaviruses, SARS‐CoV‐2, that established a new epidemic causing COVID‐19 infection. Although people of all ages can become infected with SARS‐CoV‐2, the disease is less prevalent in the younger population, and clinical course is typically milder 1‐3 ; with only a small proportion of children suffering severe COVID‐19 manifestations requiring hospitalisation 2‐10 . On the other hand, limited evidence reported chronic cardiac diseases, respiratory diseases (such as asthma), and obesity as prominent comorbidities associated with critical COVID‐19 illness in children 11,12 …”

“…Although people of all ages can become infected with SARS-CoV-2, the disease is less prevalent in the younger population, and clinical course is typically milder [1][2][3] ; with only a small proportion of children suffering severe COVID-19 manifestations requiring hospitalisation. [2][3][4][5][6][7][8][9][10] On the other hand, limited evidence reported chronic cardiac diseases, respiratory diseases (such as asthma), and obesity as prominent comorbidities associated with critical COVID-19 illness in children. 11,12 In order to combat the COVID-19 pandemic, a cascade of preventive measures, usually referred to as Non-Pharmaceutical Intervention (NPI) measures, were implemented worldwide to mitigate the disease spread until effective vaccination and/or medications become available.…”