Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
Eur J Pediatr. 2022 Mar;181(3):1245-1255. doi: 10.1007/s00431-021-04276-9. Epub 2021 Nov 29.
Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.
2019 年冠状病毒病（COVID-19）在儿童中的严重程度通常低于成人。本研究描述了在非住院和住院环境中 COVID-19 患儿的详细临床特征、治疗和结局，并在全国范围内量化了 SARS-CoV-2 感染患儿住院和入住重症监护病房的相关因素。数据通过瑞士儿科监测单位从 2020 年 3 月 1 日至 10 月 31 日期间感染 SARS-CoV-2 的<18 岁儿童中收集。瑞士所有 33 家儿科医院均报告了大流行高峰期期间的非住院和住院病例。总共纳入了 678 名儿童。中位年龄为 12.2 岁（IQR 5.0-14.6），316 名（46.6%）为女性，106 名（15.6%）存在合并症。总体而言，126 名儿童住院，其中 16 名（12.7%）需要入住 ICU。合并症是多变量回归分析中唯一与住院相关的因素（比值比 3.23，95%CI 1.89 至 5.50；p 值<0.01）。有合并症的儿童并不更常需要 ICU 入院。住院儿童更常出现发热（96 [76.2%] 与 209 [38.1%]，p 值<0.01）和皮疹（16 [12.8%] 与 6 [1.1%]，p 值<0.01）。非住院儿童更常出现嗅觉/味觉丧失（73 [13.3%] 与 3 [2.4%]，p 值<0.01）。住院儿童中，34 名（27.0%）需要吸氧治疗，9 名（7.3%）需要正性肌力药物治疗，8 名（6.3%）需要机械通气治疗。28 名（4.1%）儿童出现并发症，心血管并发症最常见（12 名 [1.8%]）。记录了 3 例死亡。结论：本研究证实 COVID-19 在儿童中大多为轻度疾病。发热、皮疹和合并症与较高的入院率相关。需要持续观察以进一步了解儿科 COVID-19，指导治疗并评估儿童接种疫苗的必要性。已知：• SARS-CoV-2 感染在儿童中的临床表现从无症状到需要重症监护病房入院的危急疾病不等。• 大多数研究仅基于住院儿童；目前，关于非住院儿童的数据有限。新发现：• COVID-19 的临床谱和严重程度受年龄影响：<2 岁的儿童中，发热、咳嗽和流涕是最常见的症状，而青少年中，发热、咳嗽和头痛更为常见。• 住院儿童更常出现发热和皮疹，而非住院儿童更常出现嗅觉/味觉丧失。• 有合并症的儿童更常住院，但并不更常需要入住 ICU。
