Department of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
Department of Pediatrics, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, Hubei, People's Republic of China.
PLoS Med. 2020 Jun 16;17(6):e1003130. doi: 10.1371/journal.pmed.1003130. eCollection 2020 Jun.
As of April 18, 2020, over 2,000,000 patients had been diagnosed with coronavirus disease-2019 (COVID-19) globally, and more than 140,000 deaths had been reported. The clinical and epidemiological characteristics of adult patients have been documented recently. However, information on pediatric patients is limited. We describe the clinical and epidemiological characteristics of pediatric patients to provide valuable insight into the early diagnosis and assessment of COVID-19 in children.
This retrospective, observational study involves a case series performed at 4 hospitals in West China. Thirty-four pediatric patients with COVID-19 were included from January 27 to February 23, 2020. The final follow-up visit was completed by March 16, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed for 34 pediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, interquartile range 10.00-94.25), among whom 14 males (41%) were included. All the patients in the current study presented mild (18%) or moderate (82%) forms of COVID-19. A total of 48% of patients were noted to be without a history of exposure to an identified source. Mixed infections of other respiratory pathogens were reported in 16 patients (47%). Comorbidities were reported in 6 patients (18%). The most common initial symptoms were fever (76%) and cough (62%). Expectoration (21%), vomiting (12%), and diarrhea (12%) were also reported in a considerable portion of cases. A substantial increase was detected in serum amyloid A for 17 patients (among 20 patients with available data; 85%) and in high-sensitivity C-reactive protein for 17 patients (among 29 patients with available data; 59%), whereas a decrease in prealbumin was noticed in 25 patients (among 32 patients with available data; 78%). In addition, significant increases in the levels of lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were detected in 28 patients (among 34 patients with available data; 82%) and 25 patients (among 34 patients with available data; 74%), respectively. Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82%). Ground-glass opacities, which were a typical feature in adults, were rare in pediatric patients (3%). Rapid radiologic progression and a late-onset pattern of lesions in the lobules were also noticed. Lesions in lobules still existed in 24 (among 32 patients with lesions; 75%) patients that were discharged, although the main symptoms disappeared a few days after treatment. All patients were discharged, and the median duration of hospitalization was 10.00 (8.00-14.25) days. The current study was limited by the small sample size and a lack of dynamic detection of inflammatory markers.
Our data systemically presented the clinical and epidemiological features, as well as the outcomes, of pediatric patients with COVID-19. Stratified analysis was performed between mild and moderate cases. The findings offer new insight into early identification and intervention in pediatric patients with COVID-19.
截至 2020 年 4 月 18 日，全球已有超过 200 万人被诊断患有 2019 年冠状病毒病（COVID-19），超过 14 万人死亡。最近已经记录了成年患者的临床和流行病学特征。然而，关于儿科患者的信息有限。我们描述了儿科患者的临床和流行病学特征，为儿童 COVID-19 的早期诊断和评估提供了有价值的见解。
本回顾性观察性研究涉及在华西的 4 家医院进行的病例系列研究。2020 年 1 月 27 日至 2 月 23 日期间，共纳入 34 例 COVID-19 儿科患者。最终随访于 2020 年 3 月 16 日完成。根据人口统计学数据、病史、实验室检查、影像学发现和治疗信息分析临床和流行病学特征。对 34 名年龄在 1 至 144 个月（中位数 33.00，四分位距 10.00-94.25）的 COVID-19 儿科患者进行数据分析，其中包括 14 名男性（41%）。本研究中的所有患者均表现为轻度（18%）或中度（82%）COVID-19。共有 48%的患者没有接触到已知来源的病史。16 名患者（47%）报告了其他呼吸道病原体的混合感染。6 名患者（18%）存在合并症。最常见的初始症状是发热（76%）和咳嗽（62%）。相当一部分病例还出现了咳痰（21%）、呕吐（12%）和腹泻（12%）。在 20 名可提供数据的患者中有 17 名（85%）患者的血清淀粉样蛋白 A 和 29 名可提供数据的患者中有 17 名（59%）患者的高敏 C 反应蛋白显著升高，而在 32 名可提供数据的患者中有 25 名（78%）患者的前白蛋白降低。此外，在 34 名可提供数据的患者中有 28 名（82%）和 25 名（82%）患者的乳酸脱氢酶和α-羟丁酸脱氢酶水平显著升高。28 名患者（82%）的胸部 CT 扫描显示小叶斑片状病变，而在成人中为典型特征的磨玻璃影在儿科患者中很少见（3%）。还注意到小叶病变的快速放射学进展和迟发性模式。尽管在治疗后几天主要症状消失，但在出院的 32 名患者中有 24 名（75%）患者的小叶病变仍然存在。所有患者均已出院，中位住院时间为 10.00（8.00-14.25）天。本研究受到样本量小和炎症标志物动态检测缺乏的限制。
我们的数据系统地呈现了 COVID-19 儿科患者的临床和流行病学特征以及结局。对轻度和中度病例进行了分层分析。这些发现为 COVID-19 儿科患者的早期识别和干预提供了新的见解。
