Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results from an Italian Multicenter Study

Abstract

Background: Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. Methods:The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020.Results: As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission (p < 0.01) and linearly to length of stay (p = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications (p < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission (p < 0.05).Garazzino et al. SARS-CoV-2 in Children and AdolescentsConclusions: Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.

SARS-CoV-2 Among Infants &lt;90 Days of Age Admitted for Serious Bacterial Infection Evaluation

“…Lower WBC, ANC, and ALC values were observed among SARS-CoV-2 infants in all analysis groups, consistent with what has been reported in some pediatric COVID-19 studies. 13,[33][34][35][36][37] No differences in chest imaging results were observed among infants with and without SARS-CoV-2, consistent with findings from older children described in the literature. 29 We recommend clinicians avoid using laboratory or imaging results to guide decision-making on whether or not to test hospitalized infants for SARS-CoV-2.…”

Gestione del Covid-19 in età pediatrica: documento di consenso

“…La maggior parte dei pazienti pediatrici SARS-CoV-2 positivi presenta quadri clinici asintomatici/lievi. Nonostante la scarsa concordanza delle evidenze 5,52,53 , si possono individuare tre fattori che influenzano la decisione di ricoverare un bambino positivo: gravità della malattia, comorbidità e compliance familiare. Uno studio recente svolto in Emilia-Romagna pone l'attenzione sull'importanza di una adeguata gestione territoriale per la riduzione del tasso di ricovero di questi bambini 54 .…”

“…I bambini con patologie croniche, in particolare malattie polmonari croniche, cardiache, neuromuscolari, oncologiche e deficit immunitari sono a maggior rischio di sviluppare una malattia grave, anche se le casistiche riportate sono limitate e il rischio rimane comunque basso 5,53,54 . In questi casi viene consigliato il ricovero.…”

Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalized children: a multicenter cohort study

“…Previous studies have attempted to identify risk factors for severe disease in pediatric patients for severe SARS-CoV-2 infection. [4][5][6][7][8][9][10][11][12][13][14] Some risk factors such as presence of comorbidities, obesity, and increased inflammatory markers have been implicated, 5,8,[10][11][12][13]15 but many studies were small and there is substantial heterogeneity. 16 Importantly, most major studies were from high-income countries and data from low and middle-income countries are scarce.…”