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

DOI
https://doi.org/10.6061/clinics/2021/e3488
Journal volume & issue
Vol. 76

Abstract

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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.

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