Baseline characteristics, management, and outcomes of 55,270 children and adolescents diagnosed with COVID-19 and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: an international network cohort study
Authors: Duarte-Salles Talita , Vizcaya David , Pistillo Andrea , Casajust Paula , Sena Anthony G. , Lai Lana Yin Hui , Prats-Uribe Albert , Ahmed Waheed-Ul-Rahman , Alshammari Thamir M , Alghoul Heba , Alser Osaid , Burn Edward , You Seng Chan , Areia Carlos , Blacketer Clair , DuVall Scott , Falconer Thomas , Fernandez-Bertolin Sergio , Fortin Stephen , Golozar Asieh , Gong Mengchun , Tan Eng Hooi , Huser Vojtech , Iveli Pablo , Morales Daniel R. , Nyberg Fredrik , Posada Jose D. , Recalde Martina , Roel Elena , Schilling Lisa M. , Shah Nigam H. , Shah Karishma , Suchard Marc A. , Zhang Lin , Zhang Ying , Williams Andrew E. , Reich Christian G. , Hripcsak George , Rijnbeek Peter , Ryan Patrick , Kostka Kristin , Prieto-Alhambra Daniel 
Published: October 2020

Objectives

To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children/adolescents diagnosed or hospitalized with COVID-19. Secondly, to describe health outcomes amongst children/adolescents diagnosed with previous seasonal influenza.

Design

International network cohort.

Setting

Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases.

Participants

Diagnosed and/or hospitalized children/adolescents with COVID-19 at age <18 between January and June 2020; diagnosed with influenza in 2017-2018.

Main outcome measures

Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome (ARDS), multi-system inflammatory syndrome (MIS-C), and death.

Results

A total of 55,270 children/adolescents diagnosed and 3,693 hospitalized with COVID-19 and 1,952,693 diagnosed with influenza were studied.

Comorbidities including neurodevelopmental disorders, heart disease, and cancer were all more common among those hospitalized vs diagnosed with COVID-19. The most common COVID-19 symptom was fever. Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more common in COVID-19 than influenza.

In-hospital treatments for COVID-19 included repurposed medications (<10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%).

Hospitalization was observed in 0.3% to 1.3% of the COVID-19 diagnosed cohort, with undetectable (N<5 per database) 30-day fatality. Thirty-day outcomes including pneumonia, ARDS, and MIS-C were more frequent in COVID-19 than influenza.

Conclusions

Despite negligible fatality, complications including pneumonia, ARDS and MIS-C were more frequent in children/adolescents with COVID-19 than with influenza. Dyspnea, anosmia and gastrointestinal symptoms could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19.

What is already known on this topic?

Most of the early COVID-19 studies were targeted at adult patients, and data concerning children and adolescents are limited.

Clinical manifestations of COVID-19 are generally milder in the pediatric population compared with adults.

Hospitalization for COVID-19 affects mostly infants, toddlers, and children with pre-existing comorbidities.

What this study adds

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This study comprehensively characterizes a large international cohort of pediatric COVID-19 patients, and almost 2 million with previous seasonal influenza across 5 countries.

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Although uncommon, pneumonia, acute respiratory distress syndrome (ARDS) and multi-system inflammatory syndrome (MIS-C) were more frequent in children and adolescents diagnosed with COVID-19 than in those with seasonal influenza.

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Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more frequent in COVID-19, and could help to differentiate pediatric COVID-19 from influenza.

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A plethora of medications were used during the management of COVID-19 in children and adolescents, with great heterogeneity in the use of antiviral therapies as well as of adjunctive therapies.