Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

  1. Marzia Lazzerini
  2. Idanna Sforzi
  3. Sandra Trapani
  4. Paolo Biban
  5. Davide Silvagni
  6. Giovanna Villa
  7. Jessica Tibaldi
  8. Luca Bertacca
  9. Enrico Felici
  10. Giuseppina Perricone
  11. Roberta Parrino
  12. Claudia Gioè
  13. Sara Lega
  14. Mariasole Conte
  15. Federico Marchetti
  16. Annamaria Magista
  17. Paola Berlese
  18. Stefano Martelossi
  19. Francesca Vaienti
  20. Enrico Valletta
  21. Margherita Mauro
  22. Roberto Dall’Amico
  23. Silvia Fasoli
  24. Antonio Gatto
  25. Antonio Chiaretti
  26. Danica Dragovic
  27. Paola Pascolo
  28. Chiara Pilotto
  29. Ilaria Liguoro
  30. Elisabetta Miorin
  31. Francesca Saretta
  32. Gian Luca Trobia
  33. Antonella Di Stefano
  34. Azzurra Orlandi
  35. Fabio Cardinale
  36. Riccardo Lubrano
  37. Alessia Testa
  38. Marco Binotti
  39. Valentina Moressa
  40. Egidio Barbi
  41. Benedetta Armocida
  42. Ilaria Mariani
  43. on behalf of COVID-19 Italian Pediatric Study Network

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Abstract

Very few studies describe factors associated with COVID-19 diagnosis in children.

Aim

We here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy.

Methods

We included cases aged 0–18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19.

Results

Among 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARS-CoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52–90.55; p < 0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19–5.02; p < 0.0001), fever (AOR: 3.05%; 95% CI: 1.67–5.58; p = 0.0003) and anosmia/ageusia (AOR: 4.08; 95% CI: 1.69–9.84; p = 0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered.

Conclusion

Recommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with pre-existing conditions.

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  1. Version published to 10.2807/1560-7917.es.2021.26.14.2001248
  2. ScreenIT

    SciScore for 10.1101/2021.03.17.21253610: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were analyzed with STATA 14 and SAS 9.4.
    STATA
    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:
    Epidemiological data on COVID-19, due also to limitations in the currently available technology for COVID-19 diagnosis (i.e., high rates of false negatives with nasal or nasopharyngeal swabs [45]) may not reflect the real incidence of the disease in each setting, and should, in general, be interpreted with extreme caution. Further studies should document knowledge, attitudes, and practices of case finding and contact tracing in Italy as well as in other settings. More accurate, acceptable, and sustainable tools are also needed for COVID-19 diagnosis. Limitations of this study include the retrospective nature of data, possible selection bias toward more symptomatic cases due to the nature of the network, and the limitation in the technology currently available for COVID-19 diagnosis. Although the use of swabs is currently recommended as the “gold standard” for COVID-19 diagnosis, it has as major limitation of a high percentage of false negative cases [45]. Future studies, when better diagnostic tools will be available, should aim to confirm the observations of the present study. Strengths of this study include its pragmatic and descriptive nature, and the involvement of many pediatric centers in the national territory. More clinical and epidemiological studies are needed to further document the real incidence, presentation, risk factors and outcomes of children with COVID-19 infection in different pediatric subpopulations, to better characterize children at higher risk of the ...

    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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  3. Version published to 10.1101/2021.03.17.21253610v1 on medRxiv