학술논문
Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children
Document Type
Original Paper
Author
Tagarro, Alfredo; Cobos-Carrascosa, Elena; Villaverde, Serena; Sanz-Santaeufemia, Francisco-Javier; Grasa, Carlos; Soriano-Arandes, Antoni; Hernanz, Alicia; Navarro, María Luisa; Pino, Rosa; Epalza, Cristina; Batista, Rosa; Rizo, Jana; Iglesias-Bouzas, María-Isabel; Rodríguez-Molino, Paula; Villanueva-Medina, Sara; Carrasco-Colom, Jaime; Alonso-Cadenas, José-Antonio; Mellado, María-José; Herrero, Blanca; Melendo, Susana; De La Torre, Mercedes; Calleja, Lourdes; Calvo, Cristina; Urretavizcaya-Martínez, María; Astigarraga, Itziar; Menasalvas, Ana; Penin, María; Neth, Olaf; Berzosa, Arantxa; De Ceano-Vivas, María; Vidal, Paula; Romero, Isabel; González, Raúl; García, María Luz; Mesa, Juan-Miguel; Ballesteros, Álvaro; Bernardino, María; Moraleda, Cinta
Source
European Journal of Pediatrics. 181(3):1105-1115
Subject
Language
English
ISSN
0340-6199
1432-1076
1432-1076
Abstract
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease.[Table Removed]