Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Institute of Maternal and Child Health, Wuhan Children's Hospital, Tongji Medical College, Huazhong University and Technology, Wuhan, China.
World J Pediatr. 2020 Jun;16(3):260-266. doi: 10.1007/s12519-020-00368-y. Epub 2020 Jun 5.
The clinical characteristics and outcome of COVID-19 in children are different from those in adults. We aimed to describe the characteristics of infants under 1 year of age (excluding newborns) with COVID-19.
We retrospectively retrieved data of 36 infants with SARS-CoV-2 infection in Wuhan Children's Hospital from January 26 to March 22, 2020. Clinical features, chest imaging findings, laboratory tests results, treatments and clinical outcomes were analyzed.
The mean age of the infected infants was 6.43 months, with a range of 2-12 months. 61.11% of the patients were males and 38.89% females. 86.11% of the infants were infected due to family clustering. Cough (77.78%) and fever (47.22%) were the most common clinical manifestations. Chest CT scan revealed 61.11% bilateral pneumonia and 36.11% unilateral pneumonia. 47.22% of the infants developed complications. Increased leucocytes, neutrophils, lymphocytes, and thrombocytes were observed in 11.11, 8.33, 36.11 and 44.44% of infants, respectively. Decreased leucocytes, neutrophils, thrombocyte and hemoglobin were observed in 8.33, 19.44, 2.78 and 36.11% of infants, respectively. Increased C-reactive protein, procalcitonin, lactate dehydrogenase, alanine aminotransferase, creatine kinase and D-dimer were observed in 19.44, 67.74, 47.22, 19.44, 22.22 and 20.69% of infants, respectively. Only one infant had a high level of creatinine. Co-infections with other respiratory pathogens were observed in 62.86% of infants. CD3 (20.69%), CD4 (68.97%), CD19 (31.03%) and Th/Ts (44.83%) were elevated; CD8 (6.9%) and CD16+CD56 (48.28%) was reduced. IL-4 (7.69%), IL-6 (19.23%), IL-10 (50%), TNF-α (11.54%) and IFN-γ (19.23%) were elevated. Up to March 22, 97.22% of infants recovered, while a critical ill infant died. When the infant's condition deteriorates rapidly, lymphocytopenia was discovered. Meanwhile, C-reactive protein, D-dimer, alanine aminotransferase, creatine kinase, creatinine, IL-6 and IL-10 increased significantly.
In the cohort, we discovered that lymphocytosis, elevated CD4 and IL-10, and co-infections were common in infants with COVID-19, which were different from adults with COVID-19. Most infants with COVID-19 have mild clinical symptoms and good prognosis.
COVID-19 在儿童中的临床特征和结局与成人不同。我们旨在描述 1 岁以下（不包括新生儿）婴儿 COVID-19 的特征。
我们回顾性检索了 2020 年 1 月 26 日至 3 月 22 日期间武汉儿童医院 36 例 SARS-CoV-2 感染婴儿的数据。分析了临床特征、胸部影像学表现、实验室检查结果、治疗和临床结局。
感染婴儿的平均年龄为 6.43 个月，范围为 2-12 个月。61.11%的患儿为男性，38.89%为女性。86.11%的婴儿因家庭聚集而感染。咳嗽（77.78%）和发热（47.22%）是最常见的临床表现。胸部 CT 扫描显示 61.11%为双侧肺炎，36.11%为单侧肺炎。47.22%的婴儿发生并发症。白细胞、中性粒细胞、淋巴细胞和血小板升高分别见于 11.11%、8.33%、36.11%和 44.44%的婴儿。白细胞、中性粒细胞、血小板和血红蛋白减少分别见于 8.33%、19.44%、2.78%和 36.11%的婴儿。19.44%、67.74%、47.22%、19.44%、22.22%和 20.69%的婴儿分别出现 C-反应蛋白、降钙素原、乳酸脱氢酶、丙氨酸氨基转移酶、肌酸激酶和 D-二聚体升高。仅 1 例婴儿肌酐水平升高。62.86%的婴儿合并其他呼吸道病原体感染。CD3（20.69%）、CD4（68.97%）、CD19（31.03%）和 Th/Ts（44.83%）升高；CD8（6.9%）和 CD16+CD56（48.28%）降低。IL-4（7.69%）、IL-6（19.23%）、IL-10（50%）、TNF-α（11.54%）和 IFN-γ（19.23%）升高。截至 3 月 22 日，97.22%的婴儿康复，而 1 例重症婴儿死亡。当婴儿病情迅速恶化时，发现淋巴细胞减少症。同时，C-反应蛋白、D-二聚体、丙氨酸氨基转移酶、肌酸激酶、肌酐、IL-6 和 IL-10 显著增加。
在本队列中，我们发现 COVID-19 婴儿常出现淋巴细胞增多、CD4 和 IL-10 升高以及合并感染，这与 COVID-19 成人不同。大多数 COVID-19 婴儿的临床症状较轻，预后良好。
