BACKGROUND AND PURPOSE:

• Götzinger et al. (The Lancet, 2020) described COVID-19 cases in children across Europe with a focus on risk factors and outcomes  

METHODS:

• Multi-center cohort study
• Setting
  • 82 health-care institutions across 25 European countries between April 1 and April 24 (peak of European pandemic)
  • Used Paediatric Tuberculosis Network European Trials Group (ptbnet), an established research network of mostly pediatric infectious disease specialists and pulmonologists
• Participants
  • All individuals ≤18 years with RT-PCR confirmed SARS-CoV-2 infection
• Study design
  • The authors examined outcomes as well as factors associated with
    • Need for ICU admission
    • Initiation of drug treatment for COVID-19

RESULTS:

• 582 children included
  • Median age: 5.0 years (IQR 0.5 to 12.0)
  • Sex ratio: 1.15 males per female
  • Pre-existing medical condition: 25% (145 patients)
• ICU admission: 8% (48 patients)
• Mechanical ventilation: 4% (25 patients)
  • Inotropic support: 3% (19 patients)
  • Extracorporeal membrane oxygenation: <1% (1 patient)
  • Median duration: 7 days (IQR 2 to 11, range 1 to 34)
• Risk factors for ICU admission
  • Being younger than 1 month: Odds ratio (OR) 5.06 (95% CI, 1.72 to 14. 87; p=0.0035)
  • Male sex: OR 2.12 (95% CI 1.06 to 4.21; p=0.033)
  • Pre-existing medical conditions: OR 3.27 (95% CI, 1.67 to 6.42; p=0.0015)
  • Presence of lower respiratory tract infection signs or symptoms at presentation: OR 10.46 (95% CI, 5.16 to 21.23; p<0.0001)
• Drug treatments used
  • Hydroxychloroquine: 7% (40 patients)
  • Remdesivir: 3% (17 patients)
  • Lopinavir–ritonavir: 1% (6 patients)
  • Oseltamivir: 1% (3 patients)
• Immunomodulatory medication used
  • Corticosteroids: 4% (22 patients)
  • Intravenous immunoglobulin: 1% (7 patients)
  • Tocilizumab: 1% (4 patients)
  • Anakinra: 1% (3 patients)
  • Siltuximab: <1% (1 patient)
• Outcomes at study end
  • Died: 4 children
    • Case-fatality rate (CFR): 0.69% (95% CI 0.20 to 1.82)
  • Alive: 578 children
    • Still symptomatic or requiring respiratory support: 4% (25 patients)

CONCLUSION:

• In this cohort of children, COVID-19 was generally mild
  • Multisystem Inflammatory Syndrome in Children (MIS-C) cases were being reported as this study went for publication
• However, 8% of children developed severe disease requiring ICU admission
  • The greatest risk factors for ICU admission: <1 month | Male sex | Pre-existing medical conditions | Lower respiratory infection at presentation
• and in addition, the authors state

Considering that many children with mild disease will never have been brought to medical attention, and therefore not diagnosed, it is highly probable that the true CFR is substantially lower than the figure of 0.69% observed in our cohort

Learn More – Primary Sources:

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Related ObG Topics:

A Possible Explanation for Differing Rates of COVID-19 Infection between Adults and Children

Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19

Hyperinflammatory Shock in Children and COVID-19

NEJM Correspondence: Clinical Course of COVID-19 in Children