COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Abstract

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5•0 years (IQR 0•5-12•0) and a sex ratio of 1•15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5•06, 95% CI 1•72-14•87; p=0•0035), male sex (2•12, 1•06-4•21; p=0•033), pre-existing medical conditions (3•27, 1•67-6•42; p=0•0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10•46, 5•16-21•23; p<0•0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0•69%, 95% CI 0•20-1•82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs...

Characteristics and Outcome of Children Admitted with Sars- Cov-2 Infection:&nbsp;Experiences from a Pediatric Public Hospital in Western India&nbsp;&nbsp;

“…Atypical presentations like seizures (10.6%) and gastrointestinal symptoms (12.2%) were more common as compared to other studies. [7,9,12,14] Seizure and diarrhea as presenting symptoms was more common in Group I.…”

“…(Table II) A systematic review in adults concluded that co-morbidities like Hypertension, Cardiovascular disease, Diabetes, and chronic renal diseases were signi cantly associated with mortality [20]. A study of children from the European cohort concluded that neonates, male sex, pre-existing medical conditions, fever, lower respiratory tract infection, radiological changes of pneumonia or ARDS, and viral co-infection were associated with more severe course on univariate analysis; however, the study did not compare these parameters to mortality [14]. In our cohort, male sex, hypoxia (SpO2 <94% ) on admission, need for respiratory support, inotropes, intensive care, length of hospital stay <10 days was signi cantly associated with mortality on univariate analysis.…”

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

“…According to the currently available evidence, SARS-CoV-2 infection in children is rarely associated with severe disease ( 1 ), children are less likely to be infected compared with adults, and children are likely to be less infectious compared with infective adults ( 2 , 3 ). However, multiple cases of children with a new hyperinflammatory condition in children subsequent to SARS-CoV-2 infection have been reported in Europe and the United States of America ( Tables 1 , 2 ).…”

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 ]. …”