<p>The Coronavirus Disease 2019 (COVID-19) in Children: A Study in an Iranian Children’s Referral Hospital</p>

Abstract

Background: Despite the worldwide spread of the coronavirus disease 2019 (COVID-19), the epidemiological and clinical patterns of the COVID-19 infection remain largely unclear, particularly among children. In this study, we explored the epidemiological characteristics, clinical patterns, and laboratory and imaging findings of pediatric patients with COVID-19. Materials and Methods: From March 7 to March 30, 2020, there were a total of 35 patients who had confirmed COVID-19 infection by laboratory virus nucleic acid test (RT-PCR) assay with throat swab samples or typical chest CT manifestation compatible with COVID-19, in addition to a history of close contact with suspected or confirmed SARS-CoV-2 in family members. Information recorded included demographic data, medical history, exposure history, underlying comorbidities, symptoms, signs, laboratory findings and radiologic assessments, severity of disease, treatment, and mortality. Results: The median age of the patients was 7.5 years (IQR=4-11; range=4 months to 15 years). A total of 63% were male. Cough was present in 80% of the patients, followed by fever (77%), nausea or vomiting (29%), diarrhea (26%), shortness of breath (29%), headache (20%), and myalgia (14%). Lymphopenia was present in 43% of the patients, thrombocytopenia in 9%, neutopenia in 8%, and leucopenia in 26%. We reported severe pneumonia in 40% of the hospitalized patients and 18 (51%) had underlying diseases. Of 35 patients, 11 had positive RT-PCR results (31%). The chest CT images of 24 patients (69%) suggested COVID-19, while their RT-PCR assays from throat swab samples were negative. Conclusion: This study demonstrates different clinical findings of pediatrics compared to the previous reports of children. Since a high rate of false negative RT-PCR test was observed, early detection of children with COVID-19 infection by CT is conducive to reasonable management and early treatment.

Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran

“…MIS-C is mainly related to a hyperinflammatory responses triggered by SARS-CoV-2. Cytokine storm experienced by children with MIS-C may derive from the ability of SARS-CoV-2 to block types I and III interferon responses as well as strong expression of cytokines and chemokines [8, 9].…”

Reinfection risk of novel coronavirus (CoVID-19): A systematic ‎review of current evidence

“…The symptoms of CoVID-19 are high temperature, dry cough, shortness of breath, headache, tiredness, loss of taste or smell, and gastrointestinal symptoms such as diarrhea, anorexia, nausea, and abdominal pain[ 6 - 8 ]. Increased liver enzyme and low counts of lymphocytes (lymphocytopenia) along with increased C-reactive protein (CRP) levels are often present in CoVD-19 patients[ 9 ]. It could eventually lead to acute respiratory distress syndrome (ARDS) and death[ 1 , 10 , 11 ].…”

COVID-19 in Neonates, A Case Series Study from Tertiary Neonatal Centers in Iran

“…The accurate prevalence rate of neonatal COVID-19 is unknown. Although the incidence of the more severe form of the disease is higher in infants (< 1 year) compared to older children (10.6% vs. 7.3, 4.2, 4.1, and 3.0% among the 1 -5, 6 -10, 11 -15, and > 15 years olds, respectively) (4), but according to several recently published case reports from various countries, the severity of this potentially lethal virus in adults is much lower than in children (5). The virus affects several organs, including the respiratory system (as the most severe involvement), cardiovascular, gastrointestinal (GI) tract, neurological, skin, hematologic, immunologic, and renal system, and liver failure (6).…”