Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China

Abstract

Aims and background: The COVID-19 outbreak spread in China and is a threat to the world. We reported on the epidemiological, clinical, laboratory, and radiological characteristics of children cases to help health workers better understand and provide timely diagnosis and treatment.

Methods: Retrospectively, two research centers' case series of 67 consecutive hospitalized cases including 53 adult and 14 children cases with COVID-19 between 23 Jan 2020 and 15 Feb 2020 from Jinan and Rizhao were enrolled in this study. Epidemiological, clinical, laboratory, and radiological characteristics of children and adults were analyzed and compared.

Results: Most cases in children were mild (21.4%) and conventional cases (78.6%), with mild clinical signs and symptoms, and all cases were of family clusters. Fever (35.7%) and dry cough (21.4%) were described as clinical manifestations in children cases. Dry cough and phlegm were not the most common symptoms in children compared with adults (p = 0.03). In the early stages of the disease, lymphocyte counts did not significantly decline but neutrophils count did in children compared with adults (p = 0.02). There was a lower level of CRP (p = 0.00) in children compared with adults. There were 8 (57.1%) asymptomatic cases and 6 (42.9%) symptomatic cases among the 14 children cases. The age of asymptomatic patients was younger than that of symptomatic patients (p = 0.03). Even among asymptomatic patients, 5 (62.5%) cases had lung injuries including 3 (60%) cases with bilateral involvement, which was not different compared with that of symptomatic cases (p = 0.58, p = 0.74).

Conclusions: The clinical symptoms of children are mild, there is substantial lung injury even among children, but that there is less clinical disease, perhaps because of a less pronounced inflammatory response, and that the occurrence of this pattern appears to inversely correlate with age.

Keywords: Children; Clinical characteristics; Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus-2.

Fig. 1

a Transverse chest CT images from a 42-year-old man showing bilateral multiple lobular and subsegmental areas in the lung on day 7 after symptom onset. b Transverse chest CT images from a 35-year-old woman showing unilateral lobular and subsegmental areas in the lung on day 5 after symptom onset. c Transverse chest CT images from a 5-year-old male child showing mild bilateral bronchiolitis in the lung on day 5 after symptom onset. d Transverse chest CT images from a 16-year-old male child showing no obvious lesion in the lung on day 8 after symptom onset