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. 2021 Aug 17;10(7):757-765.
doi: 10.1093/jpids/piab035.

COVID-19 in a Subset of Hospitalized Children in Israel

Shalom Ben-Shimol  1   2 , Gilat Livni  3 , Orli Megged  4 , David Greenberg  1   2 , Dana Danino  1   2 , Ilan Youngster  5   6 , Yael Shachor-Meyouhas  7 , Halima Dabaja-Younis  7 , Oded Scheuerman  8 , Meirav Mor  6   9 , Eli Somekh  6   10 , Husam Yakub Hanna  6   10 , Noga Givon-Lavi  1   2 , Alex Guri  11   12 , Eugene Leibovitz  1   2 , Yoav Alkan  13 , Daniel Grupel  14 , Uri Rubinstein  15 , Zohar Steinberg Ben Zeev  16 , Ellen Bamberger  17 , Amir Asher Kuperman  18   19 , Galia Grisaru-Soen  20 , Diana Tasher  21 , Giora Gottesman  22 , Daniel Glikman  23   24 , Michal Stein  25   26
Affiliations

COVID-19 in a Subset of Hospitalized Children in Israel

Shalom Ben-Shimol et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children.

Methods: An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals).

Results: Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded.

Conclusions: At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.

Keywords: SARS-CoV-2; children; coronavirus disease 2019 (COVID-19); multisystem inflammatory syndrome in children (MIS-C); pediatric inflammatory multisystem syndrome (PIMS).

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Figures

Figure 1.
Figure 1.
Study population: COVID-19 in children treated in 20 hospitals in Israel, March 11, 2020 through March 15, 2021.
Figure 2.
Figure 2.
Dynamics of COVID-19 in children in 20 hospitals in Israel, March 11, 2020 through March 15, 2021.
See this image and copyright information in PMC

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