Wang Xianyao, Ma Ruiling, Zhong Wenshan, Lin Haipeng, Zhou Hachao, Xiao Zhiwei, Lin Shaofen, Guo Yutao, Zheng Xufeng, Lin Mingxiang
Department of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, China.
Shantou University Medical College, Shantou, Guangdong, China.
Front Pediatr. 2025 Aug 21;13:1627428. doi: 10.3389/fped.2025.1627428. eCollection 2025.
Since 2019, COVID-19 has substantially impacted global public health. Although pediatric cases generally manifest with mild symptoms, severe and even fatal outcomes have occurred. Despite the decreased viral transmissibility and pathogenicity observed in the post-pandemic era, identifying early clinical indicators for severe pediatric COVID-19 remains crucial.
A retrospective cohort study analyzed 287 hospitalized pediatric COVID-19 patients admitted from December 2022 to August 2023. Clinical and laboratory data were compared between severe/critical and mild/moderate groups using univariable and multivariable analyses.
Among hospitalized patients, 82.2% were under 3 years, and severe or critical illness occurred in 32.8%. Fatigue (OR = 2.505, 95% CI: 1.359-4.615, = 0.003) and hoarseness (OR = 2.781, 95% CI: 1.188-6.510, = 0.018) were independent predictors of severity in multivariable analysis. In univariable analysis, elevated white blood cell counts, neutrophil percentage, procalcitonin (PCT), and reduced bicarbonate (CO₂) levels were also significantly associated with severe disease. All deaths ( = 3) involved children aged 1-1.5 years with acute necrotizing encephalopathy (ANE), two of whom also met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C).
Pediatric COVID-19 hospitalizations predominantly involved children under 3 years of age. Fatigue was independently associated with severe or critical illness, potentially indicating early neurological involvement. Hoarseness was frequently observed in severe cases. Based on our cohort, particular attention may be warranted for children aged 1-1.5 years presenting with neurological symptoms, as all fatal cases ( = 3) in this age group were associated with acute necrotizing encephalopathy (ANE), and two were additionally complicated by multisystem inflammatory syndrome in children (MIS-C).
自2019年以来，新型冠状病毒肺炎（COVID-19）对全球公共卫生产生了重大影响。尽管儿科病例通常表现为轻症，但也出现了重症甚至死亡病例。尽管在疫情后时代观察到病毒传播性和致病性有所下降，但确定儿童重症COVID-19的早期临床指标仍然至关重要。
一项回顾性队列研究分析了2022年12月至2023年8月收治的287例住院儿童COVID-19患者。采用单变量和多变量分析比较重症/危重症组与轻症/中症组的临床和实验室数据。
在住院患者中，82.2%为3岁以下儿童，32.8%发生了重症或危重症。在多变量分析中，疲劳（OR = 2.505，95%CI：1.359 - 4.615，P = 0.003）和声音嘶哑（OR = 2.781，95%CI：1.188 - 6.510，P = 0.018）是疾病严重程度的独立预测因素。在单变量分析中，白细胞计数、中性粒细胞百分比、降钙素原（PCT）升高以及碳酸氢盐（CO₂）水平降低也与重症显著相关。所有死亡病例（n = 3）均为1 - 1.5岁患有急性坏死性脑病（ANE）的儿童，其中2例还符合儿童多系统炎症综合征（MIS-C）的诊断标准。
儿童COVID-19住院病例主要为3岁以下儿童。疲劳与重症或危重症独立相关，可能提示早期神经系统受累。重症病例中经常观察到声音嘶哑。基于我们的队列研究，对于出现神经系统症状的1 - 1.5岁儿童可能需要特别关注，因为该年龄组的所有死亡病例（n = 3）均与急性坏死性脑病（ANE）相关，且其中2例还并发了儿童多系统炎症综合征（MIS-C）。
