Storch-de-Gracia Pilar, Leoz-Gordillo Inés, Andina David, Flores Patricia, Villalobos Enrique, Escalada-Pellitero Silvia, Jiménez Raquel
Servicio de Urgencias. Hospital Infantil Universitario Niño Jesús, Madrid, España.
Unidad de Cuidados Intensivos. Hospital Infantil Universitario Niño Jesús, Madrid, España.
An Pediatr (Engl Ed). 2020 Nov;93(5):323-333. doi: 10.1016/j.anpedi.2020.07.025. Epub 2020 Aug 31.
At this time there are still major questions about the characteristics of disease caused by the new coronavirus (COVID-19) in children as well as factors associated with the development of severe forms of the disease.
Retrospective study including patients under 18 years of age admitted with SARS-CoV-2 infection from March 1 to April 30, 2020. Infection was confirmed by realtime reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody testing. We describe the epidemiological and clinical data, laboratory and imaging findings, as well as treatment and outcome in these patients. In light of these findings, patients were classified into two severity groups and then compared.
Thirty-nine children were included, with a median age of 9 years (range 12 days-16 years); 23 were boys. Cases with uncomplicated disease course (24) mostly presented to the emergency department (ED) with fever and/or respiratory symptoms without significant alterations in laboratory findings. Of the 15 children with a complicated course, 12 developed shock. In addition to fever, they frequently presented altered appearance, extreme tachycardia, abdominal pain, vomiting, diarrhea, rash, and/or conjunctival hyperemia. They also showed greater lymphopenia (p = 0.001), elevated neutrophil/lymphocyte ratio (p = 0.001), C-reactive protein (p < 0.001), procalcitonin (p = 0.001), D-dimer (p < 0.001), and ferritin (p < 0.001).
SARS-CoV-2 infection in admitted children presents with great clinical variability. When provided supportive care, patients with predominant respiratory symptoms without altered laboratory-test results generally have an uncomplicated course. Patients with complicated disease present mainly with fever and abdominal and/or mucocutaneous symptoms. Most develop shock. Elevation of inflammatory markers may allow for early detection and the final outcome is good.
目前，关于新型冠状病毒（COVID-19）所致儿童疾病的特征以及与重症疾病发展相关的因素仍存在重大疑问。
一项回顾性研究，纳入了2020年3月1日至4月30日因感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）而入院的18岁以下患者。通过实时逆转录聚合酶链反应（RT-PCR）或抗体检测确诊感染。我们描述了这些患者的流行病学和临床数据、实验室及影像学检查结果，以及治疗情况和结局。根据这些发现，将患者分为两个严重程度组并进行比较。
纳入39名儿童，中位年龄为9岁（范围12天至16岁）；其中23名是男孩。疾病过程无并发症的病例（24例）大多因发热和/或呼吸道症状就诊于急诊科（ED），实验室检查结果无明显异常。在15例疾病过程复杂的儿童中，12例发生休克。除发热外，他们常表现为精神状态改变、极度心动过速、腹痛、呕吐、腹泻、皮疹和/或结膜充血。他们还表现出更严重的淋巴细胞减少（p = 0.001）、中性粒细胞/淋巴细胞比值升高（p = 0.001）、C反应蛋白升高（p < 0.001）、降钙素原升高（p = 0.001）、D-二聚体升高（p < 0.001）和铁蛋白升高（p < 0.001）。
入院儿童的SARS-CoV-2感染表现出很大的临床变异性。在给予支持治疗时，以呼吸道症状为主且实验室检查结果无异常的患者通常疾病过程无并发症。疾病复杂的患者主要表现为发热以及腹部和/或皮肤黏膜症状。大多数患者会发生休克。炎症标志物升高可能有助于早期发现，且最终结局良好。
