Kana Ram Jat1, Jhuma Sankar1, Rashmi Ranjan Das2, Vinod H Ratageri3, Bharat Choudhary4, Javeed Iqbal Bhat5, Baijayantimala Mishra6, Sushma Bhatnagar7, Bijayini Behera6, Bashir Ahmad Charoo5, Jagdish P Goyal4, Aditya Kumar Gupta1, Krishna Mohan Gulla2, Rani Gera8, Shivanand Illalu3, S K Kabra1, Daisy Khera4, Balbir Kumar7, Rakesh Lodha1, Anant Mohan9, Pankaj Kumar Mohanty10, Amit Kumar Satapathy2, Kuldeep Singh4, Amitabh Singh8, Sumant Vinayak Sharma11, Pawan Tiwari9, Anjan Trikha12, Prakash K Wari3. 1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. 2. Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India. 3. Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka 580021, India. 4. Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. 5. Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar 190011, India. 6. Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar 751019, India. 7. Department of Onco-anaesthesia and Palliative Medicine, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi 110029, India. 8. Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi, India. 9. Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India. 10. Department of Neonatology, All India Institute of Medical Sciences, Bhubaneswar 751019, India. 11. Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India. 12. Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India.
Abstract
INTRODUCTION: There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India. METHODS: In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome. RESULTS: We included 402 children with a median (IQR) age of 7 (2-11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease. CONCLUSION: Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.
INTRODUCTION: There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India. METHODS: In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome. RESULTS: We included 402 children with a median (IQR) age of 7 (2-11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease. CONCLUSION:Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.
Authors: Vishwa C R; Raman Sharma; Muralidharan Jayashree; Karthi Nallasamy; Arun Bansal; Suresh Kumar Angurana; Joseph L Mathew; Naveen Sankhyan; Sourabh Dutta; Sanjay Verma; Rakesh Kumar; Mahesh Devnanai; Pankaj C Vaidya; Ram Samujh; Mini P Singh; Kapil Goyal; P V M Lakshmi; Akshay K Saxena Journal: Indian J Pediatr Date: 2022-08-03 Impact factor: 5.319