SARS-CoV-2 infection in children requiring hospitalization: the experience of Navarra, Spain

Abstract

Background Coronavirus disease 2019 in children, or pediatric COVID-19, initially was described as an acute respiratory syndrome similar to the adult presentation but with less severe manifestations. Methods We describe the clinical characteristics, disease presentation, treatments and outcomes of all pediatric cases with COVID-19 admitted to the reference hospitals in Navarra, Spain during the first wave of the COVID-19 outbreak (February-May 2020). Results We found a low number of hospitalized cases in infants and children compared to adults with a hospitalization ratio of 1:180. Most of these hospitalized cases did not suffer from severe disease. Over 80% of infections reported household contacts, and the mother was the known-contact in 83% of these cases. 72% of hospitalized cases were previously healthy children. We describe how symptoms in pediatric cases are nonspecific and how COVID-19 can be presented with a wide range and variety of symptoms. Respiratory symptoms are not always present, and severe neurological and cardiac features can occur in previously healthy children. Conclusion Epidemiological description and case reports will be key to a better recognition and to adequate treatment of pediatric patients with COVID-19.

ECIEN-2020 study: the effect of COVID-19 on admissions for non-COVID-19 diseases

“…In adults the highest hospital admissions rate was registered during the first wave, around week 12th (last week of March), reaching up to 100 COVID-19 admissions per day [ 27 , 28 ]. Admission rate in children was clearly inferior, showing 10 admissions per 100,000 children in Navarra during the first wave and a ratio of 1 admitted child for every 180 hospitalized adults [ 19 ]. During the pandemic a specific hospitalization ward was opened for pediatric COVID-19 admissions at CHN Hospital, while the usual CHN hospitalization pediatric ward was kept open for admissions for non-COVID-19 pathologies, maintaining the same personal and the same bed-capacity.…”

“…A retrospective search was performed on all pediatric patients (0–15 years) admitted to the CHN pediatric service during the study period. For this specific study, only non-COVID-19 patients were analyzed; a study describing hospitalized pediatric COVID-19 patients in Navarra has previously been published [ 19 ]. The number of visits to the pediatric ED, the total number of pediatric admissions in the CHN, and the number of pediatric admissions in the observation unit, the general ward, the surgical ward and PICU were described.…”

“…In many cases, children with COVID-19 remain asymptomatic and when symptoms appear, pediatric patients usually present a greater clinical variability. Children can present with the typical adults' symptoms, such as fever, cough and respiratory distress [18], but also with a wide range of different affections, such as skin lesions, cardiac, neurological or digestive symptoms [11,12,19]. Even though pediatric cases are generally milder, severe cases as well as complications and mortality have also been described [19][20][21][22].…”

Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis

“…It is important to note that only 37 studies were included in this analysis as 5 studies only examined COVID-19associated deaths (Bellino et al, 2020;Bixler et al, 2020;Blumfield et al, 2020;Moraleda et al, 2020;Otto et al, 2020). Nonetheless, 7 studies (Anand et al, 2020, Kainth et al, 2020, Meslin et al, 2020, Moreno-Galarraga et al, 2020, Riollano-Cruz et al, 2020, Schwartz et al, 2020, Tagarro et al, 2020 had a higher risk ratio of severe COVID-19 among pediatric patients without comorbidities than those with underlying conditions (Figure 2). Furthermore, studies such as the CDC Mortality and Morbidity Weekly Report (Leeb et al, 2020) had noticeably larger participant cohort populations than other reports.…”

“…BMI) that can be compared across multiple studies. Although 64 pediatric patients with underlying obesity presented with severe COVID-19 across 13 studies (Abdel-Mannan et al, 2020;Chao et al, 2020;de Farias et al, 2020;DeBiasi et al, 2020;Derespina et al, 2020;Giacomet et al, 2020;Gonzalez-Dambrauskas et al, 2020;Kaushik et al, 2020;Lovinsky-Desir et al, 2020;Shekerdemian et al, 2020;Swann et al, 2020;Waltuch et al, 2020;Zachariah et al, 2020), we chose to perform a meta-analysis only on the studies that included case-control participants (Abdel-Mannan et al, 2020;Chao et al, 2020;Giacomet et al, 2020;Moreno-Galarraga et al, 2020;Swann et al, 2020;Zachariah et al, 2020). Examining the risk of obesity on COVID-19 severity in relation to children without comorbidities and SARS-CoV-2 infection, we obtained a relative risk ratio of 2.87 (95% J o u r n a l P r e -p r o o f CI 1.16 -7.07; 2 = 7.81 (P = 0.17); I 2 = 36%) ( Figure 6).…”