key: cord-0923779-fjhjy16f authors: Berksoy, Emel; Kanik, Ali; Çiçek, Alper; Bardak, Şefika; Elibol, Pelin; Demir, Gülşah; Yilmaz, Nisel; Nalbant, Tuğçe; Gökalp, Gamze; Yilmaz Çiftdoğan, Dilek title: Clinical and laboratory characteristics of children with SARS‐CoV‐2 infection date: 2021-09-13 journal: Pediatr Pulmonol DOI: 10.1002/ppul.25654 sha: d00d48abf52fd0f91edb1803d31dc0b2e2f6b886 doc_id: 923779 cord_uid: fjhjy16f We describe the demographic, clinical, radiological, and laboratory findings of 422 children (0–18 year‐of‐age) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection admitted to a pediatric emergency department between March 23, and July 23, 2020. We compared the characteristics of SARS‐CoV‐2‐positive patients to SARS‐CoV‐2‐negative patients. SARS‐CoV‐2 infection was confirmed in 78 (18.4%). Fever (51.2%) and cough (43.5%) were the most commonly reported signs in the SARS‐CoV‐2‐positive patients. Isolated rhinorrhea (7.2%) was reported only in the SARS‐CoV‐2‐negative group (p = .0014). Patients with SARS‐CoV‐2 infection were classified according to severity, with the percentages of asymptomatic, mild, moderate, severe, and critical cases determined to be 29.5%, 56.4%, 12.9%, 1.2%, and 0%, respectively. Of the 422 children, 128 (30.3%) underwent nasopharyngeal polymerase chain reaction testing for other respiratory viral pathogens; 21 (16.4%) were infected with viral pathogens other than SARS‐CoV‐2. Only one patient (4.7%) with confirmed coronavirus disease 2019 (COVID‐19) disease was coinfected with respiratory syncytial virus and rhinovirus. The results indicate lower median white blood cell, neutrophil, and lymphocyte counts, lower lactate dehydrogenase, d‐dimer, and procalcitonin levels in the SARS‐CoV‐2‐positive group (p ≤ .001). Our findings confirm that COVID‐19 in children has a mild presentation. In our cohort, no patient with SARS‐CoV‐2 infection had isolated rhinorrhea. revealed that the majority of children and adolescents infected with SARS-CoV-2 had a milder disease course and a very low fatality rate compared with infected adults. Accordingly, 5% of pediatric cases were severe, and 0.6% of them had critical COVID-19. 4 Since the first pediatric COVID-19 case was identified on January 20, 2020, several studies have described the epidemiological and clinical features of COVID-19 in pediatric patients. 3, 5 Differential diagnosis of COVID-19 can be challenging because its signs and symptoms (e.g., fever, cough, and rhinitis) are similar to those caused by other respiratory pathogens (RPs), which represent a common reason of admission to emergency rooms. [5] [6] [7] [8] [9] Moreover, as the pandemic continues, the number of children infected by SARS-CoV-2 is increasing gradually. In this study, we aimed to determine the demographic, clinical, and laboratory characteristics of children suspected of having SARS-CoV-2 infection admitted to the pediatric emergency room during the first 4 months of the pandemic in İzmir, the third-largest city in Western Turkey. We also aimed to evaluate coinfections with other community-acquired respiratory tract pathogens. We followed the periodic updates of case definitions in the national guidelines of the Ministry of Health, Turkey. In accordance with the guidelines, we assessed suspected cases based on epidemiological characteristics (household exposure or a history of contact with an individual who tested positive for SARS-CoV-2 infection) or respiratory system findings such as tachypnea, acute cough, or oxygen saturation measured by pulse oximetry less than 92% in room air or history of fever (body temperature ≥ 38°C). A quantitative realtime reverse transcriptase-polymerase chain reaction (qRT-PCR) test was requested in asymptomatic patients when at least two members of the same household were diagnosed with COVID-19, and in infants less than 9 months of age with a mother diagnosed with COVID-19, in accordance with the national guidelines. However, national guidelines for the evaluation of contact risk were not available at the time of the study, so we performed the nasopharyngeal PCR test for SARS-CoV-2 in asymptomatic patients with a contact history over the previous 14 days, regardless of the day of contact. A complete blood count (CBC) and C-reactive protein (CRP) levels were obtained for all symptomatic patients in accordance with the national guidelines. Additional laboratory tests such as serum electrolytes, procalcitonin, alanine aminotranferase, aspartate aminotranferase, creatine phosphokinase (CPK), creatinine, and coagulation parameters (including D-dimer and fibrinogen) were performed in patients who required hospitalization. 10 As the first-line screening modality, due to the long qRT-PCR turnaround time, chest X-ray (CXR) was performed for each symptomatic patient suspected of having COVID-19 disease. In accordance with the national guidelines, chest computed tomography (CT) was performed when CXR did not explain respiratory findings, and in cases showing clinical deterioration or the presence of infiltration on CXR. Chest CT without contrast agent was performed using a Siemens Go Up with a 1-mm slice thickness and 1-mm increments. If the CXR was normal, chest CT was performed with a 2-mm slice thickness to reduce the examination time and thus the irradiation dose. Demographic, clinical, laboratory, radiologic features, the SARS-CoV-2 PCR test results, the presence of other RPs detected with the nasopharyngeal swab, pre-existing comorbidities, and disposition were recorded using a standardized case report form. Means, standard deviations, medians, interquartile ranges (IQRs), and percentiles were calculated for discrete and continuous Only three patients with confirmed COVID-19 had a pre-existing comorbidity. One of these patients had been followed up by the pediatric neurology clinic due to developmental delay and epilepsy. This patient had mild COVID-19, and his household contact history was positive. The second patient, who had asthma, also had mild COVID-19 and a positive contact in the family. These two patients were discharged from the emergency room and followed up at home. The third patient, who had been investigated and followed up due to neurometabolic disease and a possible genetic disorder, was the patient exposed to SARS-CoV-2 via an unknown source. The latter was admitted to the inpatient ward for moderate COVID-19. All three patients recovered. Of the SARS-CoV-2-positive cases, 65 (89%) had normal CXR findings on admission. Chest CT was performed in 26 (40%) of those Studies of pediatric patients with COVID-19 have increased during the pandemic. 5, 9, 11 Clarifying the clinical, laboratory, and radiographic characteristics of pediatric patients is important for differential diagnosis of SARS-CoV-2 infection from other viral respiratory infections, particularly in busy emergency departments. We report that some clinical and laboratory characteristics differed between SARS- study, 78.2% had an adult household contact, similar to prior reports. [12] [13] [14] However, the route of transmission was not identified for 21.8% of the cases. We could not evaluate other transmission routes because schools were closed during the study period, and none of the children had a history of hospitalization or foreign travel. Lu et al. 14 reported that the median age of 171 pediatric patients was 6.7 years (1 day-15 years). Wu et al. 15 reported that the median age of infected children was 6 years, and almost half were aged 3-10 years. Dong et al. 4 reported that the median age of SARS-CoV-2-negative and -positive patients was 7 years. In this study, the median age of infected children was 11 years (1 day-18 years), comparable to that of the 2572 pediatric confirmed cases in the United States. Nearly half of the confirmed cases were aged above 12 years, possibly because adolescents are more active and spend more time outside the home. The proportion of boys was slightly higher than that of girls, in agreement with previous epidemiological studies. 4, 14, 15 In children, COVID-19 has a favorable clinical course and is typically mild. In this study, more than half of the confirmed cases were mild, and one-third were asymptomatic and admitted to the emergency room after a family member had been diagnosed with COVID-19. More than half of the patients with a history of contact were SARS-CoV-2-negative by PCR. We did not test those who tested negative at first screening multiple times, even if they were admitted. Therefore, this may be an underestimation, as swab sam- Lactate dehydrogenase (LDH) and CRP levels are high and positively correlated with COVID-19 severity in adult patients. 31, 32 Similarly, elevations of CPK and D-dimer levels have been reported in severe pediatric cases. 33 We found significant differences in all CBC parameters (WBC, neutrophil, lymphocyte, and platelet counts), acute-phase reactants, LDH, and CPK. Nevertheless, the median laboratory values of the SARS-CoV-2positive patients were in the normal ranges. There were several limitations to this study. Further epidemiological studies with higher numbers of patients are needed to verify these data in the future. World Health Organization. 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The authors declare that there are no conflict of interests. Dilek Yilmaz Çiftdoğan https://orcid.org/0000-0002-1065-9066