key: cord-0767754-r8bxop2t authors: Romani, Lorenza; Chiurchiù, Sara; Santilli, Veronica; Bernardi, Stefania; Lombardi, Mary Haywood; Scarselli, Alessia; Villani, Alberto; Ciofi Degli Atti, Marta Luisa; Campana, Andrea; D’Argenio, Patrizia title: COVID‐19 in Italian pediatric patients: the experience of a tertiary children’s hospital date: 2020-07-08 journal: Acta Paediatr DOI: 10.1111/apa.15465 sha: 4a03925d72593f343a5052ec12b3735cc6af71ea doc_id: 767754 cord_uid: r8bxop2t Coronavirus disease (COVID‐19) caused by the novel SARS‐CoV‐2 has spread worldwide since its onset in Wuhan in December 2019. In Italy COVID‐19 rapidly increased in February 2020 and by 12 May 2020, 2.0 % of the confirmed cases were under 18 years and 3.7% of those had been hospitalized. This case series report reviews the demographic characteristics, clinical course, laboratory findings, radiologic features and treatment of children admitted with COVID‐19 to a tertiary care hospital in Italy. 24 its onset in Wuhan in December 2019. In Italy COVID-19 rapidly increased in February 2020 and 25 by 12 May 2020, 2.0 % of the confirmed cases were under 18 years and 3.7% of those had been 26 hospitalized (1). This case series report reviews the demographic characteristics, clinical course, 27 laboratory findings, radiologic features and treatment of children admitted with COVID-19 to a 28 tertiary care hospital in Italy. Table 1 . Thirty-eight on forty-three children belonged to a family cluster. In 14/38 41 (37%) of cases the family member was a health care worker. 42 The symptoms at the admission are reported in Table 1. 43 On 43 patients, 5 children (12%) developed new symptoms during hospitalization including: 44 respiratory symptoms requiring supplemental oxygen for three days in a 7 years-old-boy, mild 45 diarrhoea with spontaneous resolution of ileal thickening detected on ultrasound in a 12-years-old 46 girl, conjunctival hyperemia without SARS-CoV-2 detected on ocular surface in a 6 years-old-boy 47 and the hyperinflammatory syndrome in 15-and-14 years old boys. These two patients were 48 admitted with fever and cough at the onset of the disease; after two days and three weeks from the 49 admission respectively, they developed abdominal pain, diarrhoea, high fever associated to 50 lymphopenia, high levels of inflammatory indexes (C -reactive protein, ferritin, D-dimer) and a 51 progressive mild heart failure. The transfer to the PICU was necessary. The clinical course and 52 treatment of these two patients will not be discussed in this brief report. 53 Patients laboratory findings at the admission are presented in Table 1 . 87 and that its effect is reinforced by azithromycin (4). Antiviral treatment has been used in only one 88 immunocompromised patient but data on its efficacy in children with COVID-19 are missing (2). 89 Pending on a pediatric clinical trial we included lopinavir-ritonavir in our guidelines. Chest X ray was performed in 14/43 (33%) patients while only 5/43 (12%) children 60 were subjected to chest CT scan. In 2/43 (5%) children over the age of 12 years the CT scan 61 showed more extensive lung involvement than the X-ray, with ground glass opacities: one 62 monolateral and one bilateral Because of the co-administration of drugs that potentially could prolong QT, routine ECGs were 66 performed every 48-72 hours We 69 observed bradycardia (HR 50-60 bpm) likely related to drug-drug interaction between the two 70 drugs (HCQ and lopinavir-ritonavir)and misdiagnosed. Multiple hypothesis have been proposed to justify the different 76 clinical presentation of COVID-19 between adults and children; still today there is no a univocal 77 explanation. Noteworthy, although a small percentage is reported, pediatric patients may develop a 78 hyperinflammatory syndrome that needs to be carefully evaluated for a prompt treatment. Notably, 79 adults have a much higher prevalence of increased C-reactive protein, suggesting a much milder 80 immunological response and less immune-mediated tissue damage in children (3) Epidemiology for public health, Istituto Superiore di Sanità (ISS) Systematic review of COVID-19 in children shows milder cases and a 110 better prognosis than adults Clinical and epidemiological features of 36 children with 112 coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study Hydroxychloroquine and azithromycin as a treatment of 115 COVID-19: results of an open-label non-randomized clinical trial Clinical and epidemiological characteristics of pediatric SARS CoV-2 infections in China: A multicenter case series