tetano
Editor, Senior Moderator
Clinics (Sao Paulo)
. 2021 Nov 26;76:e3488.
doi: 10.6061/clinics/2021/e3488. eCollection 2021.
Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
Heloisa Helena de Sousa Marques[SUP] 1 [/SUP], Maria Fernanda Badue Pereira[SUP] 1 [/SUP], Angélica Carreira Dos Santos[SUP] 1 [/SUP], Thais Toledo Fink[SUP] 1 [/SUP], Camila Sanson Yoshino de Paula[SUP] 1 [/SUP], Nadia Litvinov[SUP] 1 [/SUP], Claudio Schvartsman[SUP] 1 [/SUP], Artur Figueiredo Delgado[SUP] 1 [/SUP], Maria Augusta Bento Cicaroni Gibelli[SUP] 1 [/SUP], Werther Brunow de Carvalho[SUP] 1 [/SUP], Vicente Odone Filho[SUP] 1 [/SUP], Uenis Tannuri[SUP] 1 [/SUP], Magda Carneiro-Sampaio[SUP] 1 [/SUP], Sandra Grisi[SUP] 1 [/SUP], Alberto José da Silva Duarte[SUP] 1 [/SUP], Leila Antonangelo[SUP] 1 [/SUP], Rossana Pucineli Vieira Francisco[SUP] 1 [/SUP], Thelma Suely Okay[SUP] 1 [/SUP], Linamara Rizzo Batisttella[SUP] 1 [/SUP], Carlos Roberto Ribeiro de Carvalho[SUP] 1 [/SUP], Alexandra Valéria Maria Brentani[SUP] 1 [/SUP], Clovis Artur Silva[SUP] 1 [/SUP], HC-FMUSP Pediatric COVID Study Group; Adriana Pasmanik Eisencraft[SUP] 2 [/SUP], Alfio Rossi Junior[SUP] 2 [/SUP], Alice Lima Fante[SUP] 2 [/SUP], Aline Pivetta Cora[SUP] 2 [/SUP], Amelia Gorete A de Costa Reis[SUP] 2 [/SUP], Ana Paula Scoleze Ferrer[SUP] 2 [/SUP], Anarella Penha Meirelles de Andrade[SUP] 2 [/SUP], Andreia Watanabe[SUP] 2 [/SUP], Angelina Maria Freire Gonçalves[SUP] 2 [/SUP], Aurora Rosaria Pagliara Waetge[SUP] 2 [/SUP], Camila Altenfelder Silva[SUP] 2 [/SUP], Carina Ceneviva[SUP] 2 [/SUP], Carolina Dos Santos Lazari[SUP] 2 [/SUP], Deipara Monteiro Abellan[SUP] 2 [/SUP], Emilly Henrique Dos Santos[SUP] 2 [/SUP], Ester Cerdeira Sabino[SUP] 2 [/SUP], Fabíola Roberta Marim Bianchini[SUP] 2 [/SUP], Flávio Ferraz de Paes Alcantara[SUP] 2 [/SUP], Gabriel Frizzo Ramos[SUP] 2 [/SUP], Gabriela Nunes Leal[SUP] 2 [/SUP], Isadora Souza Rodriguez[SUP] 2 [/SUP], João Renato Rebello Pinho[SUP] 2 [/SUP], Jorge David Avaizoglou Carneiro[SUP] 2 [/SUP], Jose Albino Paz[SUP] 2 [/SUP], Juliana Carvalho Ferreira[SUP] 2 [/SUP], Juliana Ferreira Ferranti[SUP] 2 [/SUP], Juliana de Oliveira Achili Ferreira[SUP] 2 [/SUP], Juliana Valéria de Souza Framil[SUP] 2 [/SUP], Katia Regina da Silva[SUP] 2 [/SUP], Kelly Aparecida Kanunfre[SUP] 2 [/SUP], Karina Lucio de Medeiros Bastos[SUP] 2 [/SUP], Karine Vusberg Galleti[SUP] 2 [/SUP], Lilian Maria Cristofani[SUP] 2 [/SUP], Lisa Suzuki[SUP] 2 [/SUP], Lucia Maria Arruda Campos[SUP] 2 [/SUP], Maria Beatriz de Moliterno Perondi[SUP] 2 [/SUP], Maria de Fatima Rodrigues Diniz[SUP] 2 [/SUP], Maria Fernanda Mota Fonseca[SUP] 2 [/SUP], Mariana Nutti de Almeida Cordon[SUP] 2 [/SUP], Mariana Pissolato[SUP] 2 [/SUP], Marina Silva Peres[SUP] 2 [/SUP], Marlene Pereira Garanito[SUP] 2 [/SUP], Marta Imamura[SUP] 2 [/SUP], Mayra de Barros Dorna[SUP] 2 [/SUP], Michele Luglio[SUP] 2 [/SUP], Mussya Cisotto Rocha[SUP] 2 [/SUP], Nadia Emi Aikawa[SUP] 2 [/SUP], Natalia Viu Degaspare[SUP] 2 [/SUP], Neusa Keico Sakita[SUP] 2 [/SUP], Nicole Lee Udsen[SUP] 2 [/SUP], Paula Gobi Scudeller[SUP] 2 [/SUP], Paula Vieira de Vincenzi Gaiolla[SUP] 2 [/SUP], Rafael da Silva Giannasi Severini[SUP] 2 [/SUP], Regina Maria Rodrigues[SUP] 2 [/SUP], Ricardo Katsuya Toma[SUP] 2 [/SUP], Ricardo Iunis Citrangulo de Paula[SUP] 2 [/SUP], Patricia Palmeira[SUP] 2 [/SUP], Silvana Forsait[SUP] 2 [/SUP], Sylvia Costa Lima Farhat[SUP] 2 [/SUP], Tânia Miyuki Shimoda Sakano[SUP] 2 [/SUP], Vera Hermina Kalika Koch[SUP] 2 [/SUP], Vilson Cobello Junior[SUP] 2 [/SUP]
Affiliations
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.
. 2021 Nov 26;76:e3488.
doi: 10.6061/clinics/2021/e3488. eCollection 2021.
Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
Heloisa Helena de Sousa Marques[SUP] 1 [/SUP], Maria Fernanda Badue Pereira[SUP] 1 [/SUP], Angélica Carreira Dos Santos[SUP] 1 [/SUP], Thais Toledo Fink[SUP] 1 [/SUP], Camila Sanson Yoshino de Paula[SUP] 1 [/SUP], Nadia Litvinov[SUP] 1 [/SUP], Claudio Schvartsman[SUP] 1 [/SUP], Artur Figueiredo Delgado[SUP] 1 [/SUP], Maria Augusta Bento Cicaroni Gibelli[SUP] 1 [/SUP], Werther Brunow de Carvalho[SUP] 1 [/SUP], Vicente Odone Filho[SUP] 1 [/SUP], Uenis Tannuri[SUP] 1 [/SUP], Magda Carneiro-Sampaio[SUP] 1 [/SUP], Sandra Grisi[SUP] 1 [/SUP], Alberto José da Silva Duarte[SUP] 1 [/SUP], Leila Antonangelo[SUP] 1 [/SUP], Rossana Pucineli Vieira Francisco[SUP] 1 [/SUP], Thelma Suely Okay[SUP] 1 [/SUP], Linamara Rizzo Batisttella[SUP] 1 [/SUP], Carlos Roberto Ribeiro de Carvalho[SUP] 1 [/SUP], Alexandra Valéria Maria Brentani[SUP] 1 [/SUP], Clovis Artur Silva[SUP] 1 [/SUP], HC-FMUSP Pediatric COVID Study Group; Adriana Pasmanik Eisencraft[SUP] 2 [/SUP], Alfio Rossi Junior[SUP] 2 [/SUP], Alice Lima Fante[SUP] 2 [/SUP], Aline Pivetta Cora[SUP] 2 [/SUP], Amelia Gorete A de Costa Reis[SUP] 2 [/SUP], Ana Paula Scoleze Ferrer[SUP] 2 [/SUP], Anarella Penha Meirelles de Andrade[SUP] 2 [/SUP], Andreia Watanabe[SUP] 2 [/SUP], Angelina Maria Freire Gonçalves[SUP] 2 [/SUP], Aurora Rosaria Pagliara Waetge[SUP] 2 [/SUP], Camila Altenfelder Silva[SUP] 2 [/SUP], Carina Ceneviva[SUP] 2 [/SUP], Carolina Dos Santos Lazari[SUP] 2 [/SUP], Deipara Monteiro Abellan[SUP] 2 [/SUP], Emilly Henrique Dos Santos[SUP] 2 [/SUP], Ester Cerdeira Sabino[SUP] 2 [/SUP], Fabíola Roberta Marim Bianchini[SUP] 2 [/SUP], Flávio Ferraz de Paes Alcantara[SUP] 2 [/SUP], Gabriel Frizzo Ramos[SUP] 2 [/SUP], Gabriela Nunes Leal[SUP] 2 [/SUP], Isadora Souza Rodriguez[SUP] 2 [/SUP], João Renato Rebello Pinho[SUP] 2 [/SUP], Jorge David Avaizoglou Carneiro[SUP] 2 [/SUP], Jose Albino Paz[SUP] 2 [/SUP], Juliana Carvalho Ferreira[SUP] 2 [/SUP], Juliana Ferreira Ferranti[SUP] 2 [/SUP], Juliana de Oliveira Achili Ferreira[SUP] 2 [/SUP], Juliana Valéria de Souza Framil[SUP] 2 [/SUP], Katia Regina da Silva[SUP] 2 [/SUP], Kelly Aparecida Kanunfre[SUP] 2 [/SUP], Karina Lucio de Medeiros Bastos[SUP] 2 [/SUP], Karine Vusberg Galleti[SUP] 2 [/SUP], Lilian Maria Cristofani[SUP] 2 [/SUP], Lisa Suzuki[SUP] 2 [/SUP], Lucia Maria Arruda Campos[SUP] 2 [/SUP], Maria Beatriz de Moliterno Perondi[SUP] 2 [/SUP], Maria de Fatima Rodrigues Diniz[SUP] 2 [/SUP], Maria Fernanda Mota Fonseca[SUP] 2 [/SUP], Mariana Nutti de Almeida Cordon[SUP] 2 [/SUP], Mariana Pissolato[SUP] 2 [/SUP], Marina Silva Peres[SUP] 2 [/SUP], Marlene Pereira Garanito[SUP] 2 [/SUP], Marta Imamura[SUP] 2 [/SUP], Mayra de Barros Dorna[SUP] 2 [/SUP], Michele Luglio[SUP] 2 [/SUP], Mussya Cisotto Rocha[SUP] 2 [/SUP], Nadia Emi Aikawa[SUP] 2 [/SUP], Natalia Viu Degaspare[SUP] 2 [/SUP], Neusa Keico Sakita[SUP] 2 [/SUP], Nicole Lee Udsen[SUP] 2 [/SUP], Paula Gobi Scudeller[SUP] 2 [/SUP], Paula Vieira de Vincenzi Gaiolla[SUP] 2 [/SUP], Rafael da Silva Giannasi Severini[SUP] 2 [/SUP], Regina Maria Rodrigues[SUP] 2 [/SUP], Ricardo Katsuya Toma[SUP] 2 [/SUP], Ricardo Iunis Citrangulo de Paula[SUP] 2 [/SUP], Patricia Palmeira[SUP] 2 [/SUP], Silvana Forsait[SUP] 2 [/SUP], Sylvia Costa Lima Farhat[SUP] 2 [/SUP], Tânia Miyuki Shimoda Sakano[SUP] 2 [/SUP], Vera Hermina Kalika Koch[SUP] 2 [/SUP], Vilson Cobello Junior[SUP] 2 [/SUP]
Affiliations
- PMID: 34852143
- DOI: 10.6061/clinics/2021/e3488
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.