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).Conclusions: 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.

Factors Associated With Severe Gastrointestinal Diagnoses in Children With SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome

“… 5 , 6 Evidence from a large multicenter study in Italy showed that diarrhea occurs in about 15% of children with COVID-19, with a more frequent presentation in infancy, and vomiting (10%) or abdominal pain (8%) have a higher frequency in school-aged children. 7 …”

Diosmectite inhibits the interaction between SARS-CoV-2 and human enterocytes by trapping viral particles, thereby preventing NF-kappaB activation and CXCL10 secretion

“…A substantial number of patients with the novel coronavirus disease 2019 (COVID-19) experience gastrointestinal (GI) symptoms 1 – 3 . Prevalence estimates vary between studies, with higher rates noted among children 4 , but up to 39.6% of all patients with COVID-19 are believed to experience associated diarrhea 5 . The prognostic implications of diarrhea in patients with COVID-19 requires further investigation, but there is increasing evidence of correlations with both disease severity and survival 6 , 7 .…”

Incidence rate of MIS‐C in paediatrics: A good reason to vaccinate children against SARS‐CoV‐2

“…In Italy, paediatric SARS‐CoV‐2 infection presented in most cases with few symptoms or even in asymptomatic form, although nearly 20% of children enrolled in a nationwide registry developed complications, especially in the presence of comorbidities. 1 However, in some children and adolescents, SARS‐CoV‐2 infection was associated with the so‐called multisystemic inflammatory disease (MIS‐C), which required hospitalisation and therapies. MIS‐C is thought to be caused by a postinfectious inflammatory process and manifests clinically with signs and symptom like those of Kawasaki disease (KD) but is also marked by clinical manifestations unusual in KD, particularly gastrointestinal complaints and myocarditis, often leading to myocardial failure and shock.…”