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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 14
| Issue : 2 | Page : 134-136 |
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Clinical and demographic profile of pediatric COVID-19 in a tertiary care teaching Hospital
Suryakant Sayanna Mundlod, Deepali Abhijit Ambike, Sabahat Ahmed, Abhijeet Byale
Department of Pediatrics, PGI-YCMH, Pune, Maharashtra, India
| Date of Submission | 02-Nov-2020 |
| Date of Decision | 02-Dec-2020 |
| Date of Acceptance | 04-Dec-2020 |
| Date of Web Publication | 3-Mar-2021 |
Correspondence Address:
Deepali Abhijit Ambike
Department of Pediatrics, PGI-YCMH, Pimpri, Pune - 411 018, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mjdrdypu.mjdrdypu_606_20
Background: Coronavirus disease 2019 (COVID-19) is a disease that emerged from the global epicenter Wuhan, China in December 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Globally, there was an explosion of the outbreak of SARS-COV-2 infections, triggering a major health concern all over the world. By June 2020, the World Health Organization confirmed a total of approximately 9 million COVID-19 cases that included 477634 deaths (5.2%) in 216 countries. Materials and Methods: All COVID suspect children admitted in the pediatric ward were screened for SARS-CoV-2 by reverse transcription-polymerase chain reaction. Presenting between May 1, 2020 and August 31, 2020 and their demographic and clinical parameters were analyzed. Results: In the present study, out of 158 confirmed COVID-19 positive pediatric cases, history of high-risk contact was seen in 21 cases, history of international travel in 6 cases, history of residing in containment areas in 17 cases and co-existing disease was found in 3 cases. Fever was seen in 49 cases, cough in 21 cases, sore throat in 3 cases, shortness of breath in 6 cases, headache in 1 case, rhinorrhea in 7 cases, nausea/vomiting in 7 cases, abdominal pain in 4 cases, and diarrhea in 6 cases. Conclusion: The study highlighted that children are less vulnerable and at a lower risk of developing COVID-19 and when they contract the COVID-19 infection, they have a milder or asymptomatic disease than adults with few or minimum complications.
Keywords: Coronavirus disease 2019, paediatric age group, tertiary care hospital
How to cite this article:
Mundlod SS, Ambike DA, Ahmed S, Byale A. Clinical and demographic profile of pediatric COVID-19 in a tertiary care teaching Hospital. Med J DY Patil Vidyapeeth 2021;14:134-6 |
How to cite this URL:
Mundlod SS, Ambike DA, Ahmed S, Byale A. Clinical and demographic profile of pediatric COVID-19 in a tertiary care teaching Hospital. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Apr 12];14:134-6. Available from: https://www.mjdrdypv.org/text.asp?2021/14/2/134/310714 |
| Introduction | |  |
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In December 2019, a series of acute respiratory diseases occurred in Wuhan, China, now called COVID-19.[1] The disease has rapidly spread from Wuhan to other regions. The World Health Organization (WHO) named the disease COVID-19.[2],[3] On January 30, 2020, the WHO declared it a Public Health Emergency of International Concern and on April 11, 2020, it was declared a pandemic.[4] In India, first case was reported on 31 January in Kerala state. In Maharashtra, on 10 March first case was documented in Pune. The patient's clinical manifestations include fever, dry cough, dyspnea, myalgia, fatigue, normal or decreased white blood cell count, and imaging evidence of pneumonia.[5]
Though there have been a growing number of studies focused on COVID-19, limited data is available on epidemiological features, clinical manifestations, and transmission patterns in children with COVID-19, more so from India. Early observations in a pandemic are critical in improving the understanding of the physiological patterns and varied clinical profiles, to improve early recognition and appropriate management.
The aim of our study is to analyze the demographic and clinical parameters of pediatric patients with COVID-19 after diagnosis through detection of viral nucleic acid by reverse transcription-polymerase chain reaction seen at a dedicated single COVID care center.
| Materials and Methods | | |
This was cohort based-longitudinal study conducted in a dedicated pediatric COVID-19 Tertiary care hospital and Postgraduate Institute in Pune, Maharashtra between May 1, 2020, and August 31, 2020. Prior approval was taken from the Institutional ethics committee on 12/06/2020 vide letter no YCMH/5/KAVI/710/2020. A combined oropharyngeal and nasopharyngeal swab specimens in a single viral-transport medium tube were obtained under transmission-based precautions for all children. The age group was between 1 month and 12 years of age and those who turned positive were included in the study. We also included asymptomatic children as per the management guidelines in the Taskforce. Informed consent of all parents of the admitted children was taken on admission. Pro forma sheet was filled with defining the demographic profile and clinical presentation and the recommended laboratory findings. The clinical profile was classified as mild, moderate, and severe as per the DMER Guidelines/GOI. Laboratory profile mainly hemogram, N: L ratio, D-Dimer studies, renal function test, liver function test, and chest X-ray was sent. The children were monitored daily for changes in disease severity. Discharge from the hospital was as per prescribed MOHF and ICMR guidelines which stated that asymptomatic children who tested negative for two nasopharyngeal swabs taken 24 h apart after day 14 of illness were fit for discharge.[3] Discharge criteria were changed as per changes in the ICMR guidelines.
Study
The study design involves cohort-based-longitudinal study.
Sample
All COVID-positive children admitted in the Pediatric unit from admission to discharge/death.
Study duration
May 2020 TO August 31, 2020.
Size of sample
150 as there are approximately 30–40 admissions per month.
Inclusion criteria
All COVID-19-positive cases admitted in the age group 1 month to 12 years.
Exclusion criteria
Covid Negative paediatric patients.
| Results | | |
[Table 1] depicts the demographic profile of children of COVID-19 shows 89 (56%) were <5 years and 69 (44%) were >5 years, in the under 5 age group male outnumbered females and >5 age group female outnumbered males.
[Table 2] depicts out of 158 confirmed COVID-positive pediatric cases, history of high-risk contact was seen in 21 cases, history of international travel in 6 cases, history of residing in containment area in 17 cases, and co-existing diseases was found in 3 cases, of which 2 were cardiac disease and 1 was the chronic renal disease [Table 3].
Out of 158 confirmed COVID-positive pediatric cases, symptomatic were 104 (65.83%) and 54 (34.17%) were asymptomatic positive. Fever was seen in 49 cases, cough in 21 cases, shortness of breath in 6 cases, rhinorrhoea in 7 cases, nausea/vomiting in 7 cases, abdominal pain in 4 cases, diarrhea in 6 cases, sore throat in 3 cases, and headache in 1 case.
| Discussion | | |
In the present study, out of 158 confirmed COVID-positive pediatric cases, history of high-risk contact was seen in 21 cases, history of international travel in 6 cases, history of residing in containment area in 17 cases and co-existing disease was found in 3 cases. Fever was the commonest presentation seen in 49 cases, cough in 21 cases, sore throat in 3 cases, shortness of breath in 6 cases, rhinorrhea in 7 cases, nausea/vomiting in 7 cases, abdominal pain in 4 cases, and diarrhea in 6 cases and headache in only 1 case.
As per a review study by Jun Yasuhara,[6] analysis of a data of 46 case reports and case series with 114 pediatric patients with confirmed SARS = CoV-2 infection, it was demonstrated that the predominant clinical features of COVID-19 in children were mild respiratory symptoms with fever, cough, rhinorrhea, or asymptomatic presentations. Infants presented with dyspnea more often as compared to the other age groups. Gastrointestinal symptoms with diarrhea and vomiting were seen in the older age group which was similar to our study.[6]
As per a review study that identified and analyzed 131 studies across 26 countries comprising 7780 pediatric patients, fever (59.1%), and cough (55.9%) were the most common symptoms 19.4% of children were asymptomatic which was similar to our study. Deaths of 7 children were reported (0.09%) and 11 children (0.14%) qualified for inclusion criteria for multisystem inflammatory syndrome in children, however, we did not report any mortality in our study and did not see any case of MIS-C. This review study reflects on the evidence that COVID-19 diagnosed children have an uncomplicated course and excellent prognosis which reflects in our study too.[7]
One meta-analysis of a study conducted by Yudan Ding[7] showed that 17.4% of children had asymptomatic infection, whereas we had 34.17% asymptomatic. Fever (51.2%, and cough 37.0%) were the most frequent symptoms so were ours. Another aspect highlighted the prevalence of severe illness was almost 0% which we too report the same.
According to a study by Sarangi et al.[8] 45 (90%) had positive household contact as compared to ours with 21 contacts (13.6%). Our study showed the history of international travel in 6 (9.24%), history of residing in containment area in 17 (11.04%) and co-existing diseases was found in 3 (3.12%), of which 2 were cardiac disease and 1 was chronic renal disease. There was no mortality noted in the study and so in ours.
Fallacy
The demographic profile did not include the Kuppuswamy scale as maximum patients were from migratory laborer population in our area and unemployed due to lockdown.
| Conclusion | | |
Our study highlighted that children are less vulnerable and at a lower risk of developing COVID-19. Also when they contract the COVID-19 infection, they have a milder or asymptomatic disease than adults with few or little complications. We also conclude that Respiratory symptoms were commonly followed by the gastrointestinal presentation. Future longitudinal studies are needed to understand better which patients are at increased risk for developing severe inflammation and multiorgan failure.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA 2020;323:1239-42.  |
| 2. | Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33. |
| 3. | Wang D, Hu B, Hu C, Zhu F, Liu X, zhang Jing, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. |
| 4. | Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157-60. |
| 5. | Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. |
| 6. | Jun Y, Toshiki K, Hisato T, Naokata S. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr Pulmonol 2020;55:1-5. |
| 7. | Yudan D, Haohao Y, Wenbin G. Clinical characteristics of children with COVID-19: A meta-analysis. Front Pediatr 2020;8:431. |
| 8. | Sarangi B, Reddy VS, Oswal JS, Malshe N, Patil A, Chakraborty M, et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic. Indian Pediatr 2020;57:914-7. |
[Table 1], [Table 2], [Table 3]
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