PDF(Pubmed)
Abstract：
OBJECTIVE: Beginning in December 2019, COVID-19 rapidly emerged as a global pandemic. Though its severity in children was reported to be less than that in adults, data on its epidemiology in relation to severe acute respiratory illness (SARI) caused by other microbes needed to be generated. This study compares the clinical profile and outcome of children hospitalized with COVID-19-positive and negative SARI.
METHODS: This is a prospective observational analytical study involving children 1 month to 18 years old, hospitalized with COVID-19-positive and negative SARI during the pandemic. All eligible patients were enrolled after obtaining informed parental consent. Their clinical manifestations, investigations, and outcomes were documented on a predesigned case record form. A nasopharyngeal swab sample for COVID-19 reverse transcription polymerase chain reaction was sent, and results were noted.
RESULTS: From May 2020 to July 2021, 267 children were hospitalized with a diagnosis of SARI. Out of these, 146 (54.7%) were boys and 78.7% were under five years of age. Other presentations included fever and cough, breathlessness, nausea, vomiting, diarrhea, rash, seizures, and altered sensorium. Twenty-eight patients (10.5%) tested positive for COVID-19. COVID-19 patients were similar in terms of demographic characteristics and presenting symptoms to non-COVID-19 patients but had a lower absolute lymphocyte count (p = 0.019) and higher serum alanine transaminase levels (p = 0.013). Acute respiratory distress syndrome (OR, 4.3; 95% CI, 1.8-10.0), shock (OR, 3.9; 95% CI, 1.9-7.9), and need for intensive care unit admission (OR, 9.9; 95% CI, 6.9-14) were more common in COVID-19 SARI patients. Death occurred in 18% of COVID-19 and 9% of non-COVID-19 patients (p = 0.07). SARI nonsurvivors had significantly lower blood pH and platelet counts than survivors.
CONCLUSIONS: Comparison of COVID-19-positive and negative SARI patients showed subtle differences between the two groups, with COVID-19-positive children having an increased severity of illness. Also, laboratory evidence of multiorgan dysfunction at admission was associated with higher mortality.
METHODS: This is a prospective observational analytical study involving children 1 month to 18 years old, hospitalized with COVID-19-positive and negative SARI during the pandemic. All eligible patients were enrolled after obtaining informed parental consent. Their clinical manifestations, investigations, and outcomes were documented on a predesigned case record form. A nasopharyngeal swab sample for COVID-19 reverse transcription polymerase chain reaction was sent, and results were noted.
RESULTS: From May 2020 to July 2021, 267 children were hospitalized with a diagnosis of SARI. Out of these, 146 (54.7%) were boys and 78.7% were under five years of age. Other presentations included fever and cough, breathlessness, nausea, vomiting, diarrhea, rash, seizures, and altered sensorium. Twenty-eight patients (10.5%) tested positive for COVID-19. COVID-19 patients were similar in terms of demographic characteristics and presenting symptoms to non-COVID-19 patients but had a lower absolute lymphocyte count (p = 0.019) and higher serum alanine transaminase levels (p = 0.013). Acute respiratory distress syndrome (OR, 4.3; 95% CI, 1.8-10.0), shock (OR, 3.9; 95% CI, 1.9-7.9), and need for intensive care unit admission (OR, 9.9; 95% CI, 6.9-14) were more common in COVID-19 SARI patients. Death occurred in 18% of COVID-19 and 9% of non-COVID-19 patients (p = 0.07). SARI nonsurvivors had significantly lower blood pH and platelet counts than survivors.
CONCLUSIONS: Comparison of COVID-19-positive and negative SARI patients showed subtle differences between the two groups, with COVID-19-positive children having an increased severity of illness. Also, laboratory evidence of multiorgan dysfunction at admission was associated with higher mortality.
摘要：
目标：从2019年12月开始，COVID-19迅速成为全球大流行。尽管据报道儿童的严重程度低于成人，与由其他微生物引起的严重急性呼吸系统疾病（SARI）有关的流行病学数据需要产生。这项研究比较了COVID-19阳性和阴性SARI住院儿童的临床特征和结局。
方法：这是一项前瞻性观察性分析研究，涉及1个月至18岁的儿童，大流行期间因COVID-19阳性和阴性SARI住院。所有符合条件的患者均在获得父母知情同意后进行登记。他们的临床表现，调查,结果记录在预先设计的病例记录表上.发送了用于COVID-19逆转录聚合酶链反应的鼻咽拭子样本，并注意到结果。
结果：从2020年5月至2021年7月，267名儿童因诊断为SARI而住院。在这些中，146（54.7％）为男孩，58.7％为5岁以下。其他演讲包括发烧和咳嗽，呼吸困难,恶心,呕吐,腹泻,皮疹,癫痫发作,和改变的感官。28名患者（10.5%）的COVID-19检测呈阳性。COVID-19患者的人口统计学特征和症状与非COVID-19患者相似，但绝对淋巴细胞计数较低(p=0.019)，血清丙氨酸转氨酶水平较高(p=0.013)。急性呼吸窘迫综合征（OR，4.3；95%CI，1.8-10.0），shock(OR,3.9；95%CI，1.9-7.9），以及重症监护病房入院的需要(或者，9.9；95%CI，6.9-14）在COVID-19SARI患者中更为常见。18%的COVID-19患者和9%的非COVID-19患者死亡(p=0.07)。SARI非幸存者的血液pH和血小板计数明显低于幸存者。
结论：COVID-19阳性和阴性SARI患者的比较显示两组之间存在细微差异，COVID-19阳性儿童的疾病严重程度增加。此外，入院时多器官功能障碍的实验室证据与较高的死亡率相关.
方法：这是一项前瞻性观察性分析研究，涉及1个月至18岁的儿童，大流行期间因COVID-19阳性和阴性SARI住院。所有符合条件的患者均在获得父母知情同意后进行登记。他们的临床表现，调查,结果记录在预先设计的病例记录表上.发送了用于COVID-19逆转录聚合酶链反应的鼻咽拭子样本，并注意到结果。
结果：从2020年5月至2021年7月，267名儿童因诊断为SARI而住院。在这些中，146（54.7％）为男孩，58.7％为5岁以下。其他演讲包括发烧和咳嗽，呼吸困难,恶心,呕吐,腹泻,皮疹,癫痫发作,和改变的感官。28名患者（10.5%）的COVID-19检测呈阳性。COVID-19患者的人口统计学特征和症状与非COVID-19患者相似，但绝对淋巴细胞计数较低(p=0.019)，血清丙氨酸转氨酶水平较高(p=0.013)。急性呼吸窘迫综合征（OR，4.3；95%CI，1.8-10.0），shock(OR,3.9；95%CI，1.9-7.9），以及重症监护病房入院的需要(或者，9.9；95%CI，6.9-14）在COVID-19SARI患者中更为常见。18%的COVID-19患者和9%的非COVID-19患者死亡(p=0.07)。SARI非幸存者的血液pH和血小板计数明显低于幸存者。
结论：COVID-19阳性和阴性SARI患者的比较显示两组之间存在细微差异，COVID-19阳性儿童的疾病严重程度增加。此外，入院时多器官功能障碍的实验室证据与较高的死亡率相关.
