Pediatric Infectious Diseases Unit - Hospital Dona Estefânia. CHULC Lisboa. Portugal
Background: COVID-19 is less serious in children than in adults. However, there are cases with dismal clinical outcome. The inpatient management and outcome of pediatric patients remains relatively unknown, hence the need to evaluate the clinical and imaging presentation at admission.
Methods: Observational study in pediatric inpatients admitted in a tertiary care hospital with COVID-19 pneumonia, from April to December 2020. Degree of severity of disease was stratified according to the classification by the Canadian Paediatric Society.
Results: A total of 45 cases were identified. Median age was 4,5 years [26 days - 18 years] and 49% presented with comorbidities. The cause of admission was moderate to severe difficulty breathing (44%) and prolonged fever (24%). The most frequent patterns of pneumonia were ground glass opacities alone (26%) or with peripheral consolidation (33%) bilaterally (80%) with peripherally distributed (55%). 29/45 (69%) children developed complications: hypoxemia (10), ARDS (2) and pleural effusion (5). Six children were admitted to the ICU, two of which needed invasive ventilation. Antiviral therapy was administered in 29/45 (64%) patients with hydroxychloroquine (14), lopinavir/ritonavir (9), remdesivir (6) and azithromycin in Mycoplasma pneumoniae coinfection. 42% of children presented with coinfection. Other therapies included antibiotics (77%), oxygen (40%), methylprednisolone (20%), inhaled corticosteroids (13%), bronchodilators (18%) and prophylactic enoxaparin (16%). All patients showed a favourable evolution.
Conclusions: COVID-19 treatment in children is a clinical challenge and trials in treatment management are still needed, especially in paediatrics. Signs of severe and critical illness are crucial defining the best therapy approach.
Key words: COVID-19; Pneumonia, Children