Evaluation of Clinical Characteristics, Laboratory, Radiological Findings and Outcomes of Hospitalized Children with Coronavirus Disease 2019

Abstract

Objective: We assessed our knowledge about the epidemiological, clinical characteristics, laboratory/ radiological findings, and outcomes of hospitalized children with COVID-19. Materials and Methods: This retrospective single-center study was conducted on 54 children with COVID-19 who were hospitalized from March 16, 2020, to April 26, 2020, in the Pediatric Department at Sancaktepe Training &Research Hospital Istanbul, Turkey. Results: The median age of our patients was 121.5 months (range 1-214 months), of the 54 hospitalized children, 48.1 % (n=26) were female, and 51.9% (n=28) were male. The most common symptom was cough (n=24, 44.4%). The median duration of hospitalization was five days (range 1-13 days). According to the PCR test results, 24 (44.4%) patients werepositive, and 30 (55.6%) were negative. Among 54 children, white-cell count (WBC), absolute neutrophil count (ANC) were significantly lower, and CRP levels were significantly higher in PCR negative patients. Computed tomography was performed in 26 children, and 19(73.1%) CT scans were consistent with classic/probable/indeterminate COVID-19 predominant patterns. Oxygen requirement was significantly higher in our PCR negative patients. Conclusion: As a result of the low sensitivity of PCR test results, clinicians should consider clinical signs and symptoms in deciding on the diagnosis and treatment of COVID-19.

Keywords

• children
• clinical features
• Covid-19

Coronovirus Hastalığı 2019 Tanısı ile Hastanede Yatan Çocuklarda Klinik, Laboratuar, Radyolojik Bulguların ve Sonuçların Değerlendirilmesi

Öz

Amaç: Çalışmamızda COVID-19 tanısı ile hastanede yatan çocukların epidemiyolojik, klinik özellikleri, laboratuvar / radyolojik bulguları ve sonuçları hakkındaki bilgilerimizi değerlendirdik. Materyal ve Metod: Bu retrospektif tek merkezli çalışma, 16 Mart 2020 - 26 Nisan 2020 tarihleri arasında İstanbul Sancaktepe Eğitim ve Araştırma Hastanesi Pediatri Kliniğinde yatan 54 COVID-19 tanılı çocuk hasta üzerinde gerçekleştirildi. Bulgular: Hastalarımızın ortanca yaşı 121,5 ay (1-214 ay) idi. Hastaneye yatırılan 54 çocuk hastanın % 48,'i (n = 26) kadın, %51,9'u (n = 28) erkekti. En sık görülen semptom öksürüktü (n = 24, % 44,4). Ortalama yatış süresi 5 gündü (1-13 günarasında). PCR test sonuçlarına göre 24 (% 44,4) hasta pozitif, 30 (% 55,6) hasta negatifti. 54 çocukta beyaz küre sayısı (WBC), mutlak nötrofil sayısı (ANC) anlamlı olarak düşüktü ve CRP düzeyleri PCR negative hastalarda anlamlı olarak daha yüksekti. Bilgisayarlı tomografi 26 hastamıza çekildi ve 19 (% 73,1) BT klasik / olası / belirsiz COVID-19 baskın paterni ile uyumlu idi. PCR negative hastalarımızda oksijen gereksinimi anlamlı derecede yüksekti. Sonuç: PCR test sonuçlarının düşük hassasiyetinin bir sonucu olarak, klinisyenler COVID-19'un tanı ve tedavisine karar verirken klinik belirti ve semptomları ön planda düşünmelidir.

Anahtar Kelimeler

• Çocuk
• klinik özellikleri
• Covid-19

Kaynakça

1. WHO/2019-nCoV/Situation Report-99. Geneva, Switzerland: World Health Organization. https://www.who.int/docs/default- source/ coronaviruse /situation–reports. Accessed date April 28, 2020.
2. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6): e20200702. doi:10.1542/peds.2020-0702
3. Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663-1665. doi:10.1056/NEJMc2005073
4. Castagnoli R, Votto M, Licari A, et al. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents: A systematic review. JAMA Pediatr. 2020;174(9):882–889. doi:10.1001/jamapediatrics.2020.1467
5. Paquette D, Bell C, Roy M, et al. Laboratory-confirmed COVID-19 in children and youth in Canada, January 15-April 27, 2020. Can Commun Dis Rep. 2020;46(5):121-124.doi:10.14745/ccdr.v46i06a04
6. Chao JY, Derespina KR, Herold BC, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with Coronavirus Disease 2019 at a tertiary care medical center in New York City. J Pediatr. 2020;223:14-19.e2. doi:10.1016/j.jpeds.2020.05.006
7. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with Coronavirus Disease 2019 (COVID-19) Infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868-873. doi:10.1001/jamapediatrics.2020.1948
8. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648

9. Kocabaş E, Ersöz D, Karakoç F, et al. Turkish Thoracic Society Consensus Report on diagnosis and treatment of community acquiredpneumonia in children. Turk Thoracic J. 2009;10:1-24
10. COVID-19 (SARS-CoV-2 Enfeksiyonu) Genel Bilgiler Epidemiyoloji ve Tanı. Bilimsel Danışma Kurulu Çalışması. TC Sağlık Bakanlığı 29 Haziran 2020. https://covid19.saglik.gov.tr/TR-66337/genel-bilgiler-epidemiyoloji-ve-tani. Erişim tarihi 30 Haziran, 2020.
11. Asrak HK, Belet N, Güzin AÇ et al. COVID-19’lu Çocuklarda Akciğer Grafisi, Bilgisayarlı Tomografi Endikasyonları ve Potansiyel Riskleri. http://www.cocukenfeksiyondernegi.org. Erişim tarihi 25 Mayıs, 2020.
12. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T. Coronavirus disease 2019 in children — United States, February 12–April 2, 2020. Morb Mortal Wkly Rep. 2020;69(14):422-426. doi:10.15585/MMWR.MM6914E4
13. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786
14. Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA. 2020;323(22):2249-2251. doi:10.1001/jama.2020.8259
15. Chang TH, Wu JL, Chang LY. Clinical characteristics and diagnostic challenges of pediatric COVID-19: A systematic review and meta-analysis. J Formos Med Assoc. 2020;119(5):982-989. doi:10.1016/j.jfma.2020.04.007
16. Hasan A, Mehmood N, Fergie J. Coronavirus Disease (COVID-19) and pediatric patients: A review of epidemiology, symptomatology, laboratory and imaging results to guide the development of a management algorithm. Cureus. 2020;12(3):e7485. doi:10.7759/cureus.7485
17. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. PediatrPulmonol. 2020;55(5):1169-1174. doi:10.1002/ppul.24718
18. Meng H, Xiong R, He R, et al. CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China. J Infect. 2020;81(1):e33-e39. doi:10.1016/j.jinf.2020.04.004
19. Zachariah P, Johnson CL, Halabi KC, et al. Epidemiology, clinical features, and disease severity in patients with Coronavirus Disease 2019 (COVID-19) in a children's hospital in New York City, New York. JAMA Pediatr. 2020;e1-e7. doi:10.1001/jamapediatrics.2020.2430
20. Shen KL, Yang YH, Jiang RM, et al. Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition). World J Pediatr. 2020;16(3):232-239. doi:10.1007/s12519-020-00362-4
21. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689-696. doi:10.1016/S1473-3099(20)30198-5