key: cord-0803481-63w578b2
authors: Ruan, Pei-sen; Xu, Hui-qing; Wu, Jun-hua; Song, Qi-fa; Qiu, Hai-yan
title: COVID-19 in Children: Clinical Characteristics and Follow-Up Study
date: 2020-09-03
journal: SN Compr Clin Med
DOI: 10.1007/s42399-020-00502-x
sha: 74e18666274da37c635ac090e39746623266d720
doc_id: 803481
cord_uid: 63w578b2

Since December 2019, the coronavirus disease 2019 (COVID-19) has spread globally. But the clinical symptoms and detailed follow-up of children with COVID-19 infection are lacking. Here, we conducted a retrospective study including children with confirmed COVID-19. We recorded patients’ epidemiological, clinical features, and follow-up data after discharging in order to improve the awareness and treatment of children with COVID-19.

Since December 2019, multiple patients of pneumonia infected with the emergence of severe acute respiratory syndrome coronavirus 2 disease (COVID-19) had been detected in Wuhan city, China [1] . With the spreading of the epidemic, other more patients had also founded in China and other countries [2] . At present, pediatric patients have been reported all over the world, mainly asymptomatic and mild infections. With the progress of the epidemic and the innovation of detection technology, it was not ruled out that pediatric patients were particularly severe, and the number of critically infected children had increased and died. As children were also susceptible to COVID-19 infection and they need more attention. So, analysis of the clinical characteristics, epidemiological characteristics, and follow-up results after discharge of pediatric patients with confirmed COVID-19 in this area was aimed at improving the awareness and treatment of children with COVID-19.

We retrospectively analyzed 5 children with COVID-19 admitted to Ningbo Women and Children's Hospital after diagnosed on Feb 4, 2020, to April 6, 2020. Diagnosis and discharge standards were performed according to the content of the "Diagnosis and treatment guidelines for 2019 novel coronavirus pneumonia (Trial Version 7) (In Chinese) [3] ." We observed and recorded the patient's epidemiological characteristics, clinical manifestations, laboratory tests, radiography, treatment methods, and transfer return. From the beginning of hospitalization to 4 weeks after discharge, we performed a dynamic tracking including laboratory tests, radiographic inspection, and SARS-CoV-2 RT-PCT in nasopharyngeal and feces swabs. We tested the SARS-CoV-2 of feces swabs and nasopharyngeal swabs every 2 days throughout the process. We conducted a blood laboratory and radiographic 3 times (on the day of discharge, 2 weeks after discharge, and 4 weeks after discharge). 

Between Feb 4, 2020, and April 6, 2020, 5 pediatric patients with COVID-19 were reported in Ningbo in China (aged 12-133 months; mean age 77.6 [SD 52.3] months). Two (40%) of 5 patients were female. The household registration of 3 patients was in Zhejiang province, and the other 2 were in Hubei province. All patients had no underlying disease. We found that 5 patients were all family cluster infection (100%), and there were 3 to 6 confirmed infections in the family. All of the patients contacted with adult patients with novel coronavirus pneumonia (NCP).

One patient had the symptoms of nasal congestion and runny nose (20%), which resolved after 5 days. CoV-2 detoxification time in nasopharyngeal swab was 16 (SD 5.4) days. We found patients with nasopharyngeal swabs turned negative, but SARS-CoV-2 could still be detected in the feces swabs during the same period.

We also found all patients underwent multiple lung radiation without significant changes. We traced treatments and primary manifestations to assess disease progression and outcome, and varieties of treatments were given such as bed rest, ensuring calorie intake, monitoring vital signs, interferon atomization inhalation, and bifidobacterium triple live bacteria powder. The mean time in hospital was 18 (SD 5.4) days. By Feb 26, 2020, all patients were cured and quarantined for a further 2 weeks.

Follow-up was continuing every 2 days after discharging to 4 weeks ( Table 2) . We found that the gastrointestinal detoxification time was mean 24 (SD 4.9) days, and the younger pediatric patient had decreased the time of gastrointestinal detoxification (p = 0.037). We did not find respiratory and digestive symptoms, and no abnormalities in blood laboratory and radiographic in pediatric patients. We also did not find positive RT-PCR test results in recovering COVID-19 pediatric patients.

Researchers had predicted that the R0 values of the epidemic were 6.74 [4] , which suggested that the epidemic had a strong ability to spread from person to person. There were fewer cases of COVID-19 infection in children than in adults, and it was more common in children with asymptomatic infection and mild and common infection, and the clinical symptoms were usually mild [5] . Familial clustering was the main way for children to be infected with COVID-19 [6] . Early laboratory tests and radiation tests could be atypical, and fecal SARS-CoV-2 measurements suggested that children in the recovery period still had the risk of being infected by excretion of the virus through fecal-oral transmission [7] . This means that virus-containing feces might be spread further by polluting the environment. Therefore, asking in detail epidemiological history was very important. Many researchers had reported that varieties of cases of recovered COVID-19 pediatric patients had positive RT-PCR test again. This might be due to biological characteristics of SARS-CoV-2 (a recombinant viruses) and might also be related to the basic disease, weak immune function, glucocorticoid using, processing and detecting of patients, and some even related to SARS-CoV-2 mutations [8] . At present, because the understanding of COVID-19 infection was limited to us, further research was needed to strengthen the early identification and early diagnosis of COVID-19 infection in children, especially in children with NCP and critically ill children with NCP. 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges

Potential for global spread of a novel coronavirus from China

National Health and Health Commission of the People's Republic of China. Diagnosis and treatment guidelines for 2019 novel coronavirus pneumonia (draft version 7)

Estimation of the transmission risk of the 2019-nCoV and its implication for public health interventions

Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

Cause analysis and treatment strategies of "recurrence" with novel coronavirus pneumonia (covid-19) patients after discharge from hospital

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Acknowledgments We would like to acknowledge all of our colleagues of the Ningbo Women and Children's Hospital.

Ethical Approval The study was approved by the Institutional Helsinki Committee, which waived the requirement to obtain written consent from the parents of studied patients.Informed consent Informed consent was obtained from the patient's parents for publication of this report.

Authors' Contributions HQ designed the study and did the literature search. JW and HX were responsible for disease diagnosis and treatment and data collection. QS collected and analyzed the data. PR analyzed the data and wrote the report.Funding This study was funded by Ningbo Clinical Research Center for Children's Health and Diseases, Project of Ningbo Reproductive Medicine Center (PPXK2018-06).