COVID-19 in children in a megalopolis: clinical, epidemiological and therapeutic aspects

Abstract

The pandemic of a new coronavirus infection in the world, including in Russia, was the basis for a detailed analysis of the disease features in children hospitalized in the only specialized hospital in Saint Petersburg. The purpose — is to analyze clinical and epidemiological data and approaches to the treatment of COVID-19 in children based on the functioning of the specialized infectious hospital, which was the first in such a megalopolis as Saint Petersburg to be deployed to work with the new coronavirus infection from January 2020 to the present. Material and methods. Based on a retrospective continuous single-center study, we analyzed 206 medical records of inpatient children aged 0 to 18 years who were treated in the Infectious Department № 7 of the Filatov municipal hospital № 5 in Saint Petersburg with a diagnosis of COVID-19 from March to June 2020. The mandatory selection criterion was laboratory confirmation of the COVID-19 diagnosis — a positive result of PCR of SARS-Cov-2 RNA in nasopharyngeal and oropharyngeal smears. The article is descriptive in nature. Results. It was found that children older than 3 years prevailed among the patients (71,5%, n = 147). Family contact with adults prevailed (54,9%, n = 113). COVID-19-ARVI was diagnosed in 81,4% (n = 168) of children, pneumonia was diagnosed in 18,6% (n = 38) of cases, and in 1,9% (n = 4) of cases it was asymptomatic. Mild forms of the disease prevailed (76,2%, n = 157), severe ones occurred only in 1,9% (n = 4) of patients. In 30,7% (n = 63) of cases, patients were admitted to a hospital late (in the second week of the disease). It was found that the clinical picture was dominated by fever (78,6%, n = 162), which lasted more than 5 days in 22,3% (n = 46) of cases, pharyngeal hyperemia — 84,5% (n = 174), cough — 51,2% (n = 105), symptoms of intestinal dysfunction — 19,4% (n = 40), anosmia — 9,9% (n = 20), exanthema — 7,8% (n = 16), sternal pain — 9,9% (n = 20). Recombinant interferon alpha-2b, umifenovir, lopinavir/ritonavir, anticoagulants, macrolides, and cephalosporins were used in the treatment of children. All patients showed positive dynamics with favorable outcome after treatment. All patients were discharged with clinical recovery. In 84,4% (n = 174) of patients sanation of nasopharynx и and fauces took place in hospital, in 62,1% (n = 128) of cases virus discharge took place on the 10–12 day, in other cases after 2–4 weeks. Conclusion. COVID-19 in children in a megalopolis has specific features compared with other ARVIs, but therapy principles are similar, implying taking into account the disease severity and early start of etiotropic treatment with the whole range of available antivirus drugs allowed for children and having an evidential basis, which was confirmed in the present research.

New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

“…Был проведен анализ 43% от всех случаев госпитализаций детей с пневмонией и 30% -с ОРЗ, вызванными SARS-CoV-2, в регионе, что позволяет считать выборку достаточно репрезентативной. В отличие от ранее опубликованных российских данных [6][7][8], мы включили в анализ не только детей с COVID-19, подтвержденной ПЦР-ОТ, но и детей с отрицательными результатами тестирования, поскольку известно, что диагностическая значимость ПЦР-ОТ составляет примерно 60% за счет ложноотрицательных результатов [10]. Имеются сведения о том, что у детей и подростков с умеренными симптомами этиологическое тестирование на COVID-19 чаще имеет отрицательный результат [11].…”

“…Не было установлено преимущественной госпитализации детей раннего возраста. В нашем исследовании частота поражения легких на КТ составила 56,4%, то есть была как минимум вдвое выше, чем в работах других российских авторов [7,8]. Обнаруженные различия могут быть обусловлены взаимодействием различных факторов: динамикой развития пандемии на конкретной территории, различающимися подходами к диагностике и госпитализации, использованием рентгенографии для диагностики пневмонии или субъективной оценкой врачами рисков у детей раннего возраста.…”

“…Более половины (58%) включенных в анализ исследований проводились в Китае, остальные -в Северной Америке, Европе и на Ближнем Востоке [5]. Результаты наблюдений из различных регионов России отражены в единичных публикациях [6][7][8].…”