Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.
JAMA Pediatr. 2020 Oct 1;174(10):e202430. doi: 10.1001/jamapediatrics.2020.2430. Epub 2020 Oct 5.
Descriptions of the coronavirus disease 2019 (COVID-19) experience in pediatrics will help inform clinical practices and infection prevention and control for pediatric facilities.
To describe the epidemiology, clinical, and laboratory features of patients with COVID-19 hospitalized at a children's hospital and to compare these parameters between patients hospitalized with and without severe disease.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective review of electronic medical records from a tertiary care academically affiliated children's hospital in New York City, New York, included hospitalized children and adolescents (≤21 years) who were tested based on suspicion for COVID-19 between March 1 to April 15, 2020, and had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay.
Severe disease as defined by the requirement for mechanical ventilation.
Among 50 patients, 27 (54%) were boys and 25 (50%) were Hispanic. The median days from onset of symptoms to admission was 2 days (interquartile range, 1-5 days). Most patients (40 [80%]) had fever or respiratory symptoms (32 [64%]), but 3 patients (6%) with only gastrointestinal tract presentations were identified. Obesity (11 [22%]) was the most prevalent comorbidity. Respiratory support was required for 16 patients (32%), including 9 patients (18%) who required mechanical ventilation. One patient (2%) died. None of 14 infants and 1 of 8 immunocompromised patients had severe disease. Obesity was significantly associated with mechanical ventilation in children 2 years or older (6 of 9 [67%] vs 5 of 25 [20%]; P = .03). Lymphopenia was commonly observed at admission (36 [72%]) but did not differ significantly between those with and without severe disease. Those with severe disease had significantly higher C-reactive protein (median, 8.978 mg/dL [to convert to milligrams per liter, multiply by 10] vs 0.64 mg/dL) and procalcitonin levels (median, 0.31 ng/mL vs 0.17 ng/mL) at admission (P < .001), as well as elevated peak interleukin 6, ferritin, and D-dimer levels during hospitalization. Hydroxychloroquine was administered to 15 patients (30%) but could not be completed for 3. Prolonged test positivity (maximum of 27 days) was observed in 4 patients (8%).
In this case series study of children and adolescents hospitalized with COVID-19, the disease had diverse manifestations. Infants and immunocompromised patients were not at increased risk of severe disease. Obesity was significantly associated with disease severity. Elevated inflammatory markers were seen in those with severe disease.
对儿科 2019 年冠状病毒病（COVID-19）的描述将有助于为儿科医疗机构提供临床实践和感染预防与控制方面的信息。
描述在一家儿童医院住院的 COVID-19 患儿的流行病学、临床和实验室特征，并比较住院期间出现和未出现严重疾病的患者的这些参数。
设计、地点和参与者：本研究是对纽约市一家三级保健学术附属儿童医院电子病历的回顾性分析，纳入 2020 年 3 月 1 日至 4 月 15 日期间因疑似 COVID-19 而接受检测且严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）检测结果为阳性的住院儿童和青少年（≤21 岁）。
使用逆转录-聚合酶链反应（RT-PCR）检测鼻咽拭子中 SARS-CoV-2 的存在。
严重疾病定义为需要机械通气。
50 例患者中，27 例（54%）为男孩，25 例（50%）为西班牙裔。从症状出现到入院的中位数天数为 2 天（四分位距，1-5 天）。大多数患者（40 例[80%]）有发热或呼吸道症状（32 例[64%]），但有 3 例（6%）仅表现为胃肠道症状。肥胖症（11 例[22%]）是最常见的合并症。16 例患者（32%）需要呼吸支持，包括 9 例（18%）需要机械通气。1 例患者（2%）死亡。14 例婴儿和 8 例免疫功能低下患者中无一例出现严重疾病。肥胖症与 2 岁及以上儿童的机械通气显著相关（6/9 [67%] vs 5/25 [20%]；P =.03）。入院时普遍存在淋巴细胞减少症（36 例[72%]），但在严重疾病患者和无严重疾病患者之间无显著差异。严重疾病患者入院时 C 反应蛋白（中位数，8.978 mg/dL[换算为毫克/升，乘以 10] vs 0.64 mg/dL）和降钙素原水平（中位数，0.31 ng/mL vs 0.17 ng/mL）显著升高（P <.001），住院期间白细胞介素 6、铁蛋白和 D-二聚体水平升高。15 例患者（30%）接受了羟氯喹治疗，但有 3 例无法完成治疗。4 例患者（8%）观察到最长 27 天的检测持续阳性。
在这项对因 COVID-19 住院的儿童和青少年进行的病例系列研究中，该疾病表现多样。婴儿和免疫功能低下患者患严重疾病的风险并未增加。肥胖症与疾病严重程度显著相关。严重疾病患者的炎症标志物升高。
