학술논문
Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
Document Type
article
Author
Marques, Heloisa Helena de Sousa; Pereira, Maria Fernanda Badue; Santos, Angélica Carreira dos; Fink, Thais Toledo; Paula, Camila Sanson Yoshino de; Litvinov, Nadia; Schvartsman, Claudio; Delgado, Artur Figueiredo; Gibelli, Maria Augusta Bento Cicaroni; Carvalho, Werther Brunow de; Odone Filho, Vicente; Tannuri, Uenis; Carneiro-Sampaio, Magda; Grisi, Sandra; Duarte, Alberto José da Silva; Antonangelo, Leila; Francisco, Rossana Pucineli Vieira; Okay, Thelma Suely; Batisttella, Linamara Rizzo; Carvalho, Carlos Roberto Ribeiro de; Brentani, Alexandra Valéria Maria; Silva, Clovis Artur; Eisencraft, Adriana Pasmanik; Rossi Junior, Alfio; Fante, Alice Lima; Cora, Aline Pivetta; Reis, Amelia Gorete A. de Costa; Ferrer, Ana Paula Scoleze; Andrade, Anarella Penha Meirelles de; Watanabe, Andreia; Gonçalves, Angelina Maria Freire; Waetge, Aurora Rosaria Pagliara; Silva, Camila Altenfelder; Ceneviva, Carina; Lazari, Carolina dos Santos; Abellan, Deipara Monteiro; Santos, Emilly Henrique dos; Sabino, Ester Cerdeira; Bianchini, Fabíola Roberta Marim; Alcantara, Flávio Ferraz de Paes; Ramos, Gabriel Frizzo; Leal, Gabriela Nunes; Rodriguez, Isadora Souza; Pinho, João Renato Rebello; Carneiro, Jorge David Avaizoglou; Paz, Jose Albino; Ferreira, Juliana Carvalho; Ferranti, Juliana Ferreira; Ferreira, Juliana de Oliveira Achili; Framil, Juliana Valéria de Souza; Silva, Katia Regina da; Kanunfre, Kelly Aparecida; Bastos, Karina Lucio de Medeiros; Galleti, Karine Vusberg; Cristofani, Lilian Maria; Suzuki, Lisa; Campos, Lucia Maria Arruda; Perondi, Maria Beatriz de Moliterno; Diniz, Maria de Fatima Rodrigues; Fonseca, Maria Fernanda Mota; Cordon, Mariana Nutti de Almeida; Pissolato, Mariana; Peres, Marina Silva; Garanito, Marlene Pereira; Imamura, Marta; Dorna, Mayra de Barros; Luglio, Michele; Rocha, Mussya Cisotto; Aikawa, Nadia Emi; Degaspare, Natalia Viu; Sakita, Neusa Keico; Udsen, Nicole Lee; Scudeller, Paula Gobi; Gaiolla, Paula Vieira de Vincenzi; Severini, Rafael da Silva Giannasi; Rodrigues, Regina Maria; Toma, Ricardo Katsuya; Paula, Ricardo Iunis Citrangulo de; Palmeira, Patricia; Forsait, Silvana; Farhat, Sylvia Costa Lima; Sakano, Tânia Miyuki Shimoda; Koch, Vera Hermina Kalika; Cobello Junior, Vilson
Source
Clinics. January 2021 76
Subject
Language
English
ISSN
1807-5932
Abstract
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.