Clinical characteristics of children with COVID-19 admitted in a tertiary referral center in Perú

  1. Christian Chiara Chilet
  2. Medalit Luna Vilchez
  3. Julio Maquera Afaray
  4. Blanca Salazar Mesones
  5. Diana Portillo Alvarez
  6. Ramiro Priale Miranda
  7. Franklin Mendoza
  8. Aldo Munayco
  9. Jenny Baca
  10. Mitsi Santiago
  11. Jose W. López

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Abstract

Introduction

COVID-19 pandemic represents a big impact on children’s health, this study describes the behavior of the disease in hospitalized pediatric patients in the Instituto Nacional de Salud del Niño San Borja (INSN-SB).

Methods

Retrospective study of patients with confirmed COVID-19 diagnostic between March and July 2020. Demographic, clinic, laboratory, radiology and treatment data were collected and for the analysis descriptive statistics were included.

Results

From a total of 91 patients. 36.3% (33) were female. The age group who was affected the most were school children with a median age of 4 years old (IQR 1-8). Patients who came from Lima represented 61.5%. Previous contact was determined in 30.8% of the cases. PCR results for SARS CoV-2 were positive in 50.6% of the cases and 49.4% in the quick tests. Comorbidity was present in 53.8% of the cases. Most frequent symptoms were fever (39.6%), general discomfort (23.1%), cough (19.8%) and shortness of breath (14.3%). Presence of MIS-C was confirmed in 6 patients. Use of antibiotics represented 76.9% of the cases. The most frequent radiology pattern was bilateral interstitial (57.7%). Comorbidities were present in 68.2% (15/22) of patients in PICU. From a total of 9 deceased patients, 6 were admitted in PICU and 8 presented associated comorbidities.

Conclusions

COVID-19 in children displays mild and moderate clinical manifestations. A great proportion of patients exhibited comorbidities, especially PICU patients and the ones that died.

What is known about the subject

In pediatric patients, the prevalence and severity of COVID-19 are usually low, however, in the presence of MIS-C, greater severity and probability of admission to the PICU is observed.

What this study adds

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    This study describes the results of complex pediatric patients and the associated comorbidity in LMIC setting that showed greater severity and admission to the ICU.

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    Microbiological isolates in cultures were low, therefore the initiation of empirical antibiotic therapy is not justified in most cases.

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    1. Version published to 10.1101/2020.09.18.20186866v2 on medRxiv
    2. ScreenIT

      SciScore for 10.1101/2020.09.18.20186866: (What is this?)

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

      Table 1: Rigor

      Institutional Review Board StatementIACUC: Clinical evaluation was managed by the attending pediatrician according to the institutional care guidelines.
      IRB: Ethical approval: The present study was approved by the Institutional Review Board of the INSN-SB with project code PI-429.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.
      Sex as a biological variablenot detected.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      The statistical analyses were performed using the STATA version 16 program (StataCorp. 2019. Stata Statistical Software: Release 16.
      STATA
      suggested: (Stata, RRID:SCR_012763)
      StataCorp
      suggested: (Stata, RRID:SCR_012763)

      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:
      Our study has some limitations. One limitation was the absence of complete baseline tests proposed for COVID-19, partly explained by the diversity of clinical criteria for the request. Finally, not all patients diagnosed with MIS-C had undergone a serological test for SARS-CoV 2, and only patients with a positive confirmatory test were included in the present study. In conclusion, SARS CoV-2 infection in children presents mild and moderate clinical manifestations, with the presence of comorbidities being an important factor for hospitalization, and high mortality upon admission to the pediatric ICU. In addition, patients presenting diagnostic criteria of MIS-C showed a favorable evolution.

      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

      SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

    3. Version published to 10.1101/2020.09.18.20186866v1 on medRxiv