Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

Abstract

Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered. Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known:• There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New:• Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease.• However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.

How COVID-19 Pandemic Changed Children and Adolescents Use of the Emergency Department: the Experience of a Secondary Care Pediatric Unit in Central Italy

“…Indeed, being our hospital qualified as COVID-19 hospital, our ED was efficiently reorganized to avoid intrahospital spread of SARS-CoV-2, separating suspected COVID-19 and standard care pathways. We detected only 1 case positive to SARS-CoV-2 (a 1.9-year-old girl admitted for complex febrile seizure) among 68 symptomatic and 47 asymptomatic patients tested with nasopharyngeal swab, confirming the low prevalence of COVID-19 among children and adolescents reported by other Italian records [7,8,17,27]. Febrile seizures represent a rare presentation of COVID-19 in pediatric age.…”

“…Published preliminary Italian data confirmed a general favorable clinical course of COVID-19 in pediatric age [7]. However, two Italian Pediatric Research Networks reported a not negligible rate of severe presentations in children with comorbidities [8]; four deaths (age ≤ 9 years) have been reported on June 28th [9].…”

Impact of COVID-19 pandemic on the characteristics of paediatric emergency room visits in a tertiary centre in Northern Italy

“…[10][11][12] Indeed, the population had become quickly aware that respiratory symptoms and fever could be warning signs for possible COVID-19, thus prompting caregivers to seek PED consultation for their children, despite the opposite recommendation by the national health service to stay at home and the low involvement of the paediatric age. [13][14][15][16] Conversely, PED visits for gastroenteritis showed a signi cantly fall in the COVID-19 period, probably because gastrointestinal symptoms were not known yet as a possible manifestation of COVID-19 by caregivers, particularly in the rst weeks of the outbreak.…”

Measures to maintain regular operations and prevent outbreaks of SARS-CoV-2 in childcare facilities or schools under pandemic conditions and co-circulation of other respiratory pathogens

“… a lower frequency of infection [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ] (some, but by far not all studies were conducted during the lockdown, which is a methodological limitation); a lower average severity of disease and associated with this; a significantly lower risk of the most serious, including fatal, courses; from CoVID-19 [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]. …”