The severity and atypical presentations of COVID-19 infection in pediatrics

Abstract

Background Emergence of 2019-nCoV attracted global attention and WHO declared COVID-19 a public health emergency of international concern. Therefore we aimed to explore the severity and atypical manifestations of COVID-19 among children. Methods This is an observational cohort study conducted on 398 children with confirmed COVID-19 by using real-time reverse transcriptase polymerase chain reaction assay for detection of 2019-nCoV nucleic acid during the period from March to November 2020. Patients were subdivided regarding the severity of COVID-19 presentation into Group I (Non-severe COVID-19) was admitted into wards and Group II (Severe COVID-19) admitted into the PICU. Results Non- severe cases were 295cases (74.1%) and 103cases (25.9%) of severe cases. There was a significant difference between age groups of the affected children (P < 0.001) with a median (0–15 years). Boys (52%) are more affected than girls (48%) with significant differences (P < 0.001). 68.6%of confirmed cases had contact history to family members infected with COVID-19. 41.7% of severe patients needed mechanical ventilation. Death of 20.4% of severe cases. In COVID-19 patients, fever, headache, fatigue and shock were the most prominent presentations (95, 60.3, 57.8, and 21.8% respectively). 3.5% of children were manifested with atypical presentations; 1.25% manifested by pictures of acute pancreatitis, 1.25% presented by manifestations of deep venous thrombosis and 1.0% had multisystem inflammatory syndrome (MIS-C). Multivariate regression analysis showed that COVID-19 severity in children was significantly higher among children with higher levels of D-dimer, hypoxia, shock and mechanical ventilation. Conclusion Most children had a non-severe type of COVID-19 and children with severe type had higher levels of D-dimer, hypoxia, shock and mechanical ventilation.

COVID-19 and Pediatric Gastroenterology

“…Acute pancreatitis (1.5%) was the most common atypical presentation of COVID-19 in this study 4 . Common lab abnormalities in hospitalized patients with COVID-19 include leukopenia, lymphopenia, elevated inflammatory markers, and abnormal liver tests 4 , 5 , 6 . Mortality rates remain low in children with 0.17 per 100,000 or 0.48% of the estimated total mortality from all causes in a normal year 7 .…”

“…A meta-analysis by Viner et al 3 showed children have a significantly lower susceptibility to COVID-19 infection with an odds ratio of 0.56 compared with adults. Saleh et al 4 specifically investigated hospitalized children with COVID-19 and found that the most common presentations were fever (95%), headache (60.3%), fatigue (57.8%), and shock (21.8%). Acute pancreatitis (1.5%) was the most common atypical presentation of COVID-19 in this study 4 .…”

“…Saleh et al 4 specifically investigated hospitalized children with COVID-19 and found that the most common presentations were fever (95%), headache (60.3%), fatigue (57.8%), and shock (21.8%). Acute pancreatitis (1.5%) was the most common atypical presentation of COVID-19 in this study 4 . Common lab abnormalities in hospitalized patients with COVID-19 include leukopenia, lymphopenia, elevated inflammatory markers, and abnormal liver tests 4 , 5 , 6 .…”

Multisystem Inflammatory Syndrome in Children

“…Recent studies have found that thrombosis has a lower incidence in children with COVID-19 compared with adults ( 48 ). However, children with MIS-C are at greater risk for hypercoagulable events compared to those with asymptomatic COVID-19 infection ( 49 ) evidence of thrombosis, coronary artery involvement, or depressed ejection fraction ( < 35%) ( 18 , 36 ).…”

Çocuklarda pankreas hasarında COVID 19’un etkisi var mı?

“…Ülkemizden de vakaların bildirilmeye başlaması ile pankreatit ve COVID-19 birlikteliği konusunda ilgi artmaya başlamıştır (32). Ancak araştırmamızla ilgili olarak ülkemizdeki literatürde sıklıkla olgu sunumları mevcut olup, sadece bir tane gözlemsel çalışmaya rastlanılmıştır (31).…”