Clinical Characteristics of 34 Children with Coronavirus Disease-2019 in the West of China: a Multiple-center Case Series
Authors: Zhang Che , Gu Jiaowei , Chen Quanjing , Deng Na , Li Jingfeng , Huang Li , Zhou Xihui 
Published: March 2020

AbstractBackgroundUp to 9 March, 2020, 109577 patients were diagnosed with coronavirus disease-2019 (COVID-19) globally. The clinical and epidemiological characteristics of adult patients have been revealed recently. However, the information of paediatric patients remains unclear. We describe the clinical and epidemiological characteristics of paediatric patients to provide valuable insight into early diagnosis of COVID-19 in children, as well as epidemic control policy making.Methods and FindingsThis retrospective, observational study was a case series performed at 4 hospitals in the west of China. Thirty-four paediatric patients with COVID-19 were included from January 1 to February 25, 2020. And the final follow-up visit was completed by February 28, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed on 34 paediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, IQR 10.00 - 94.25), among whom 14 males (41.18%) were included. 47.60% of patients were noticed without any exposure history. The median incubation period was 10.50 (7.75 - 25.25) days. Infections of other respiratory pathogens were reported in 16 patients (47.06%). The most common initial symptoms were fever (76.47%), cough (58.82%), and expectoration (20.59%). Vomiting (11.76%) and diarrhea (11.76%) were also reported in a considerable portion of cases. A remarkable increase was detected in serum amyloid A for 17 patients (85.00%) and high-sensitivity C-reactive protein for 17 patients (58.62%), while a decrease of prealbumin was noticed in 25 patients (78.13%). In addition, the levels of lactate dehydrogenase was increased significantly in 28 patients (82.35%), as well as α-hydroxybutyrate dehydrogenase in 25 patients (73.53%). Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82.36%). The typical feature of ground-glass opacity for adults was rare in paediatric patients (2.94%). A late-onset pattern of lesions in lobules were also noticed. Stratified analysis of the clinical features were not performed due to relatively limited samples.ConclusionsOur data presented the clinical and epidemiological features of paediatric patients systemically. The findings offer new insight into the early identification and intervention of paediatric patients with COVID-19.Author summaryWhy was this study done?The 2019-novel coronavirus (2019-nCoV) infection has spread worldwide rapidly.Early identification and intervention are necessary for effective epidemic control in both adults and children, however the clinical and epidemiological characteristics of paediatric patients remains unclear.What did the researchers do and find?We collected and analyzed clinical data of 34 paediatric patients with coronavirus disease-2019 (COVID-19) in 4 hospitals of China from January 1 to February 25, 2020.We described the clinical and epidemiological features of the patients, and focused on the differences in initial symptoms and radiological findings between paediatric patients and adult patients.Distinguished from adult patients, higher incidences of fever, vomiting, and diarrhea were noticed on admission in paediatric cases.Patchy shadows of high density were common in lobules lesions, while the typical features of ground-glass opacity in adults were rare in paediatric cases.A late-onset pattern of lobules lesions was revealed on the basis of chest computed tomographic scans.What do these findings mean?The specific clinical features in paediatric patients should be paid more attention to, when the physicians are dealing with suspected cases.The epidemiological model in children was characterized with dominant family cluster transmission and extended incubation period, which should be taken into consideration in policy making for epidemic control.