Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

doi:10.1007/s00431-020-03683-8

. 2020 Aug;179(8):1315-1323.

doi: 10.1007/s00431-020-03683-8. Epub 2020 Jun 3.

Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

Niccolò Parri¹, Anna Maria Magistà², Federico Marchetti³, Barbara Cantoni⁴, Alberto Arrighini⁵, Marta Romanengo⁶, Enrico Felici⁷, Antonio Urbino⁸, Liviana Da Dalt⁹, Lucio Verdoni¹⁰, Benedetta Armocida¹¹, Benedetta Covi¹¹, Ilaria Mariani¹¹, Roberta Giacchero¹², Anna Maria Musolino¹³, Marco Binotti¹⁴, Paolo Biban¹⁵, Silvia Fasoli¹⁶, Chiara Pilotto¹⁷, Flavia Nicoloso¹⁸, Massimiliano Raggi¹⁹, Elisabetta Miorin²⁰, Danilo Buonsenso^{21

22}, Massimo Chiossi²³, Rino Agostiniani²⁴, Anna Plebani²⁵, Maria Antonietta Barbieri¹³, Marcello Lanari²⁶, Serena Arrigo²⁷, Elena Zoia²⁸, Matteo Lenge^{29

30

31}, Stefano Masi¹, Egidio Barbi^{11

32}, Marzia Lazzerini³³; CONFIDENCE and COVID-19 Italian Pediatric Study Networks

Affiliations

¹ Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.
² Department of Pediatrics, Community Pediatrics, Ravenna, Italy.
³ Department of Pediatrics, Ravenna Hospital, Ravenna, Italy.
⁴ Healthcare Professional Department Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
⁵ Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy.
⁶ IRCCS Istituto Gaslini, Genoa, Italy.
⁷ Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
⁸ Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
⁹ Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy.
¹⁰ Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹¹ Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
¹² Department of Pediatrics, Lodi Hospital, Lodi, Italy.
¹³ Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy.
¹⁵ Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy.
¹⁶ Paediatric Unit, Carlo Poma Hospital, Mantua, Italy.
¹⁷ Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy.
¹⁸ Family Pediatrician, Udine, Italy.
¹⁹ ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy.
²⁰ Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy.
²¹ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²² Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy.
²⁴ Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy.
²⁵ Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy.
²⁶ Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
²⁷ Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy.
²⁸ Department of Pediatrics, Hospital V. Buzzi, Milan, Italy.
²⁹ Clinical Trial Office, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³⁰ Child Neurology Unit and Laboratories, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³¹ Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³² Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy.
³³ Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. marzia.lazzerini@burlo.trieste.it.

PMID: 32495147
PMCID: PMC7269687
DOI: 10.1007/s00431-020-03683-8

Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

Niccolò Parri et al. Eur J Pediatr. 2020 Aug.

. 2020 Aug;179(8):1315-1323.

doi: 10.1007/s00431-020-03683-8. Epub 2020 Jun 3.

Authors

Affiliations

¹ Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.
² Department of Pediatrics, Community Pediatrics, Ravenna, Italy.
³ Department of Pediatrics, Ravenna Hospital, Ravenna, Italy.
⁴ Healthcare Professional Department Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
⁵ Pediatric Emergency Department, Presidio Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy.
⁶ IRCCS Istituto Gaslini, Genoa, Italy.
⁷ Pediatric and Pediatric Emergency Unit, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
⁸ Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
⁹ Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua, Italy.
¹⁰ Department of Pediatrics, Papa Giovanni XXIII Hospital, Bergamo, Italy.
¹¹ Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
¹² Department of Pediatrics, Lodi Hospital, Lodi, Italy.
¹³ Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Neonatal and Pediatric Intensive Care Unit, Maggiore della Carità University Hospital, Novara, Italy.
¹⁵ Department of Neonatal and Paediatric Critical Care, Verona University Hospital, Verona, Italy.
¹⁶ Paediatric Unit, Carlo Poma Hospital, Mantua, Italy.
¹⁷ Division of Paediatrics, Department of Medicine DAME, Academic Hospital Santa Maria della Misericordia, University of Udine, Udine, Italy.
¹⁸ Family Pediatrician, Udine, Italy.
¹⁹ ICU, Pain Therapy Unit, Rovereto Hospital, Trento, Italy.
²⁰ Department of Pediatrics, Latisana-Palmanova, ASUFC, Udine, Italy.
²¹ Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²² Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Department of Pediatrics, ASL 4 Liguria, Lavagna, Italy.
²⁴ Department of Pediatrics, Ospedale San Jacopo, Pistoia, Italy.
²⁵ Pediatric Emergency Unit, Filippo Del Ponte Hospital, ASST-Settelaghi, Varese, Italy.
²⁶ Pediatric Emergency Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
²⁷ Department of Pediatrics, Hospital Filippo Del Ponte, Varese, Italy.
²⁸ Department of Pediatrics, Hospital V. Buzzi, Milan, Italy.
²⁹ Clinical Trial Office, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³⁰ Child Neurology Unit and Laboratories, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³¹ Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy.
³² Department of Medicine, Surgery and Health Science, Department of Pediatrics, University of Trieste, Trieste, Italy.
³³ Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. marzia.lazzerini@burlo.trieste.it.

PMID: 32495147
PMCID: PMC7269687
DOI: 10.1007/s00431-020-03683-8

Abstract

Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known: • There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New: • Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease. • However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.

Keywords: Adolescents; COVID-19; Children; Italy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Distributions of enrolled COVID-19 cases across regions in Italy

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Reading the Compass - Procedural Sedation and COVID-19.
Thikkurissy S. Thikkurissy S. Pediatr Dent. 2021 Mar 15;43(2):78-79. Pediatr Dent. 2021. PMID: 33892827 No abstract available.

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References

1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545. doi: 10.1001/jama.2020.4031. - DOI - PubMed
1. World Health organization. Coronavirus disease (COVID-2019) situation reports 79. Available at (accessed on March 27, 2020) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio...
1. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, Rovida F, Baldanti F, Marseglia GL (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr Published online April 22. 10.1001/jamapediatrics.2020.1467 - PubMed
1. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 Mar 16
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[1] Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545. doi: 10.1001/jama.2020.4031. - DOI - PubMed

[2] Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020;323:1545. doi: 10.1001/jama.2020.4031. - DOI - PubMed

[3] World Health organization. Coronavirus disease (COVID-2019) situation reports 79. Available at (accessed on March 27, 2020) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio...

[4] World Health organization. Coronavirus disease (COVID-2019) situation reports 79. Available at (accessed on March 27, 2020) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio...

[5] Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, Rovida F, Baldanti F, Marseglia GL (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr Published online April 22. 10.1001/jamapediatrics.2020.1467 - PubMed

[6] Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, Rovida F, Baldanti F, Marseglia GL (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr Published online April 22. 10.1001/jamapediatrics.2020.1467 - PubMed

[7] Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 Mar 16

[8] Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 Mar 16

[9] Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia F.J., Otheo E., Moraleda C., Calvo C. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr Published online April 08, 2020. doi:10.1001/jamapediatrics.2020.1346 - PMC - PubMed

[10] Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia F.J., Otheo E., Moraleda C., Calvo C. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr Published online April 08, 2020. doi:10.1001/jamapediatrics.2020.1346 - PMC - PubMed

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Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

Affiliations

Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks

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Abstract

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