Coronavirus (COVID-19) infection in children at a specialist centre: outcome and implications of underlying ‘high-risk’ comorbidities in a paediatric population

  1. RW Issitt
  2. J Booth
  3. WA Bryant
  4. A Spiridou
  5. AM Taylor
  6. P du Pré
  7. P Ramnarayan
  8. J Hartley
  9. M Cortina-Borja
  10. K Moshal
  11. H Dunn
  12. H Hemingway
  13. NJ Sebire

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Abstract

Background

There is evolving evidence of significant differences in severity and outcomes of coronavirus disease 2019 (COVID-19) in children compared to adults. Underlying medical conditions associated with increased risk of severe disease are based on adult data, but have been applied across all ages resulting in large numbers of families undertaking social ‘shielding’ (vulnerable group). We conducted a retrospective analysis of children with suspected COVID-19 at a Specialist Children’s Hospital to determine outcomes based on COVID-19 testing status and underlying health vulnerabilities.

Methods

Routine clinical data were extracted retrospectively from the Institution’s Electronic Health Record system and Digital Research Environment for patients with suspected and confirmed COVID-19 diagnoses. Data were compared between Sars-CoV-2 positive and negative patients (CoVPos / CoVNeg respectively), and in relation to presence of underlying health vulnerabilities based on Public Health England guidance.

Findings

Between 1 st March and 15 th May 2020, 166 children (<18 years of age) presented to a specialist children’s hospital with clinical features of possible COVID-19 infection. 65 patients (39.2%) tested positive for SARS-CoV-2 virus. CoVPos patients were older (median 9 [0.9 - 14] years vs median 1 [0.1 - 5.7.5] years respectively, p <0.001). There was a significantly reduced proportion of vulnerable cases (47.7% vs 72.3%, p =0.002), but no difference in proportion of vulnerable patients requiring ventilation (61% vs 64.3%, p = 0.84) between CoVPos and CoVNeg groups. However, a significantly lower proportion of CoVPos patients required mechanical ventilation support compared to CoVNeg patients (27.7 vs 57.4%, p <0.001). Mortality was not significantly different between CoVPos and CoVNeg groups (1.5 vs 4% respectively, p =0.67) although there were no direct COVID-19 related deaths in this highly preselected paediatric population.

Interpretation

COVID-19 infection may be associated with severe disease in childhood presenting to a specialist hospital, but does not appear significantly different in severity to other causes of similar clinical presentations. In children presenting with pre-existing ‘COVID-19 vulnerable’ medical conditions at a specialist centre, there does not appear to be significantly increased risk of either contracting COVID-19 or severe complications, apart from those undergoing chemotherapy, who are over-represented.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.20.20107904: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study design and participants: Retrospective analysis of routinely collected hospital data fulfiling the ethical guidelines of the Helsinki Declaration and approved by the Institutional Review Board as part of a wider study for the use of routine hospital data within a secure digital research environment (17/LO/0008).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the study has limitations due to its retrospective nature, lack of ‘normal’ control group being available for the patients studied, and separation by COVID-19 status without matching. This is evident in the significantly different age demographic of the two cohorts. Furthermore, as diagnostic codes classed as vulnerable will change as more data becomes available, patients classed as non-vulnerable in this study, may yet be considered vulnerable in the future and vice-versa. The main limitation is that the group represents a highly preselected population in a specialist children’s hospital of patients presenting with severe disease and therefore is not representative of the unselected paediatric population as a whole. It should also be noted that since vulnerable children are shielding at home, the pattern of presentation reported here may not be representative of a non-shielded situation. Nevertheless, these data represent a relatively large series of children presenting with similar clinical features and as such provides important data regarding the disease severity of COVID-19 in children compared to other similar infectious conditions and the potential impact of underlying medical condition vulnerability in this population. In particular, the current policy of extended shielding for vulnerable patients of all ages, represents a significant burden for patients and their families in terms of social interactions, schooling and education and childhood mental health. T...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.20.20107904v1 on medRxiv