Division of Pediatric Intensive Care, Department of Pediatrics, Derince Research and Training Hospital, Kocaeli, Turkey.
Division of Pediatric Infectious Disease, Department of Pediatrics, Derince Research and Training Hospital, Kocaeli, Turkey.
Pediatr Int. 2021 Sep;63(9):1055-1061. doi: 10.1111/ped.14602. Epub 2021 Aug 7.
To identify the clinical findings and outcomes of children with coronavirus disease 2019 (COVID-19) and factors predicting reverse transcription polymerase chain reaction (RT-PCR) positivity.
The data were analyzed retrospectively for suspected and confirmed pediatric COVID-19 patients between March 20 and May 31, 2020.
There were 404 children, of them, 176 (43.6%) patients were confirmed to have COVID-19, and 228 (56.4%) were considered suspected cases. Confirmed cases were less symptomatic on admission (67.6%-95.6%). Cough (44.9%), fever (38.1%), sore throat (18.5%), and smell-taste loss (12.7%) were the most common symptoms. Confirmed cases had a 92.6% identified history of contact with COVID-19. Close contact with COVID-19 positive family members and sore throat increased the RT-PCR positivity 23.8 and 5.0 times, respectively; while positivity decreased by 0.4 times if fever was over 38 °C. Asymptomatic and mild cases were categorized as "group 1" (n = 153); moderate, severe, and critical cases as "group 2" (n = 23) in terms of disease severity. Group 2 cases had higher C-reactive protein (40.9%-15.9%) and procalcitonin (22.7%-4.9%) levels and had more frequent lymphopenia (45.5%-13.1%). Out of 23 cases, 19 had abnormal chest radiograph findings; of them, 15 patients underwent chest computed tomographies (CTs), and all had abnormal findings. However, 26.0% of them needed respiratory support, and no patient required invasive ventilation.
Children with COVID-19 have a milder clinical course and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rarely causes severe disease in children. Contact history with COVID-19 and sore throat are the most important predictors for RT-PCR positivity. Consequently, the role of asymptomatic children in the contamination chain must be fully established and considered for the control of pandemic.
确定儿童 2019 年冠状病毒病（COVID-19）的临床特征和结局，以及预测逆转录聚合酶链反应（RT-PCR）阳性的因素。
对 2020 年 3 月 20 日至 5 月 31 日期间疑似和确诊的儿科 COVID-19 患者进行回顾性数据分析。
共纳入 404 例患儿，其中 176 例（43.6%）确诊为 COVID-19，228 例（56.4%）为疑似病例。确诊病例入院时症状较轻（67.6%-95.6%）。最常见的症状为咳嗽（44.9%）、发热（38.1%）、咽痛（18.5%）和嗅觉味觉丧失（12.7%）。确诊病例均有 92.6%的 COVID-19 接触史。与 COVID-19 阳性家庭成员的密切接触和咽痛使 RT-PCR 阳性的可能性分别增加 23.8 倍和 5.0 倍，而发热超过 38°C 时阳性率降低 0.4 倍。无症状和轻症病例归为“第 1 组”（n=153），疾病严重程度为中、重、危的病例归为“第 2 组”（n=23）。第 2 组病例的 C 反应蛋白（40.9%-15.9%）和降钙素原（22.7%-4.9%）水平更高，且更频繁出现淋巴细胞减少（45.5%-13.1%）。23 例中 19 例有异常胸部 X 线表现，其中 15 例行胸部 CT 检查，均有异常发现。但仅 26.0%的患儿需要呼吸支持，无一例患者需要有创通气。
儿童 COVID-19 临床症状较轻，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）很少导致儿童重症疾病。与 COVID-19 的接触史和咽痛是 RT-PCR 阳性的最重要预测因素。因此，必须充分确定无症状儿童在传播链中的作用，并考虑到对大流行的控制。
