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

Abstract

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region.Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4–82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7±1.0 vs. 1.1±0.5 respectively; р<0.001). The mean age of the hospitalized children was 8 years (7.4–9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3–83.0), cough (66.1%; 95% CI 57.1–74.4]), fatigues (38.7%; 95% CI 30.1–47.9), and hyposmia (33.9%; 95% CI 25.6–42.9). The severe disease course was rare (2.4%; 95% CI 0.5–6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р<0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide /fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of>5 days duration can be a predictor of pneumonia in a pediatric patient with COVID-19 (odds ratio 4.55 (2.1–9.9), sensitivity 61.4%, specificity 74.1%).Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-19.