Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy;
Contributed equally as co-first authors.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2020-009399. Epub 2020 Jul 14.
To describe the epidemiological and clinical characteristics of coronavirus disease (COVID-19) pediatric patients aged <18 years in Italy.
Data from the national case-based surveillance system of confirmed COVID-19 infections until May 8, 2020, were analyzed. Demographic and clinical characteristics of subjects were summarized by age groups (0-1, 2-6, 7-12, 13-18 years), and risk factors for disease severity were evaluated by using a multilevel (clustered by region) multivariable logistic regression model. Furthermore, a comparison among children, adults, and elderly was performed.
Pediatric patients (3836) accounted for 1.8% of total infections (216 305); the median age was 11 years, 51.4% were male, 13.3% were hospitalized, and 5.4% presented underlying medical conditions. The disease was mild in 32.4% of cases and severe in 4.3%, particularly in children ≤6 years old (10.8%); among 511 hospitalized patients, 3.5% were admitted in ICU, and 4 deaths occurred. Lower risk of disease severity was associated with increasing age and calendar time, whereas a higher risk was associated with preexisting underlying medical conditions (odds ratio = 2.80, 95% confidence interval = 1.74-4.48). Hospitalization rate, admission in ICU, disease severity, and days from symptoms onset to recovery significantly increased with age among children, adults and elderly.
Data suggest that pediatric cases of COVID-19 are less severe than adults; however, age ≤1 year and the presence of underlying conditions represent severity risk factors. A better understanding of the infection in children may give important insights into disease pathogenesis, health care practices, and public health policies.
描述意大利<18 岁儿童 COVID-19 患者的流行病学和临床特征。
分析截至 2020 年 5 月 8 日基于国家确诊 COVID-19 感染病例的监测系统数据。根据年龄组（0-1 岁、2-6 岁、7-12 岁、13-18 岁）总结研究对象的人口统计学和临床特征，并使用多层次（按地区聚类）多变量逻辑回归模型评估疾病严重程度的危险因素。此外，还比较了儿童、成人和老年人之间的差异。
儿科患者（3836 例）占总感染人数（216305 例）的 1.8%；中位年龄为 11 岁，51.4%为男性，13.3%住院，5.4%有基础疾病。32.4%的病例为轻症，4.3%为重症，特别是≤6 岁的儿童（10.8%）；在 511 例住院患者中，3.5%入住 ICU，4 例死亡。疾病严重程度的风险较低与年龄和时间的增加相关，而与预先存在的基础疾病相关的风险较高（比值比=2.80，95%置信区间=1.74-4.48）。在儿童、成人和老年人中，住院率、入住 ICU、疾病严重程度和从症状出现到康复的时间均随年龄的增加而显著增加。
数据表明，COVID-19 儿科病例的严重程度低于成人；然而，年龄≤1 岁和存在基础疾病是严重程度的危险因素。更好地了解儿童感染情况可能会为疾病发病机制、医疗保健实践和公共卫生政策提供重要的见解。
