Clinical and epidemiologic features of COVID-19 in children

1. Children with COVID-19 tended to have milder clinical manifestations, with nearly half of the infected cohort being asymptomatic.

2. Children with COVID-19 had a significantly lower prevalence of cough, fever, pneumonia, and CRP elevation compared to adults.

Evidence Rating: 3 (Average)

The clinical and characteristics of children affected by COVID-19 are relatively less well characterized than in adult patients. In this retrospective observational cohort study, the clinical presentations of 36 children (aged 0-16 years) from Zhejiang, China infected with laboratory confirmed SARS-CoV-2 were evaluated to address this knowledge gap as one of the first comprehensive studies investigating this pediatric population. The mean age of this cohort was 8.3 years (S.D. 3.5), with 13 female patients and 23 male patients. Only mild and moderate cases were included in this study, with 17 patients in the former who had upper respiratory symptoms or were asymptomatic and 19 patients in the latter group with mild pneumonia. Routes of transmission identified were either close contact with family members of a history of exposure to the epidemic area or a combination of both. Compared to previously reported symptoms of adults in the same city, the pediatric sample had lower rates of symptoms at presentation: fever (36% of total cases, 24% of mild, 47% of moderate) and dry cough (19% of all cases, 18% of mild cases, 21% of moderate cases). As a comparison, 86% and 62% of adults in the adult study presented with fever and cough, respectively. Furthermore, 28% of patients were asymptomatic, compared to <5% of the adult cohort. Elevated CK-MB (31%), decreased lymphocytes (31%), leukopenia (19%), and elevated procalcitonin (17%) were common abnormal laboratory findings. Radiographic findings on chest CT tended to consist of either multiple opacities or patchy opacities, manifesting as pulmonary ground-glass opacities. Lower lymphocyte count and higher body temperatures, procalcitonin, D-dimer, and CK-MB were correlated with increased disease severity. Mean time in hospital was 14 (SD 3) days, and all patients eventually recovered. Despite a small sample size, this study provides valuable data highlighting the differences in clinical presentation between pediatric and adult patients with COVID-19. At least preliminarily, study findings seem to suggest that children are less likely to display common symptoms on presentation and more likely to be asymptomatic, which may pose challenges in diagnosis and treatment. Follow up studies will be needed to further characterize the long-term effects of COVID-19 on affected children.

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