КЛИНИЧЕСКИЕ ОСОБЕННОСТИ ТЕЧЕНИЯ ИНФЕКЦИИ COVID-19 У ГОСПИТАЛИЗИРОВАННЫХ ДЕТЕЙ РАЗЛИЧНОГО ВОЗРАСТА

Abstract

Despite the global prevalence of Coronavirus disease 2019 (COVID-19) and the study of the disease around the world, there are many questions about the clinical course, diagnosis and prevention of new infection. There is even less research on the course of COVID-19 infection in children than in adults. The variability of symptoms in children, their frequency, severity, and prognostic value are not well understood. In order to analyze the nature of the course of COVID-19 in children of different ages, a single-center prospective open continuous controlled study was carried out, which included patients under the age of 18 years, hospitalized for one month (May 2020) with COVID-19 infection at the Urals Scientific and Research Institute for Maternal and Child Care of the Ministry of Healthcare of Russian Federation (Yekaterinburg, Sverdlovsk Oblast, Russia). The study was approved by the local ethics committee. Materials and methods of research: on the basis of the Ural Scientific Research Institute for Maternal and Child Care, 107 children 0–17 years old with mild and moderate forms of COVID-19 infection were examined. More than 70% of admitted patients are infants and preschool children. Results and discussions: the intrafamilial focus became the main source of infection. The most frequent clinical manifestations on admission were cough, pyrexia, catarrhal symptoms; on the 5–6th day, the appearance of gastrointestinal syndrome in the form of diarrhea, nausea, vomiting was noted more often in children under 3 years of age. The asymptomatic course of COVID-19 infection was observed more often in schoolchildren (up to 67% of adolescents 13–17 years old). In patients under 1 year of age, asymptomatic course was noted much less frequently (37.5%). In children under 3 years of age, pneumonia was more often confirmed (up to 33%) and gastrointestinal syndrome in the form of diarrhea, nausea, vomiting (up to 50% of patients under 1 year of age). According to laboratory data, in children under 3 years old, a decrease in erythrocytes, hemoglobin, hematocrit was more often observed, and in schoolchildren and adolescents (7–17 years old) – a decrease in leukocyte counts, lymphopenia. Conclusion: In the analysis of the course of COVID-19 infection in children of different ages, a hypothesis about two variants of clinical manifestations has been put forward. In the first variant, pneumonia with COVID-19 was characterized by persistent, poorly controlled fever, severe symptoms of intoxication, impaired microcirculation, changes in the electrocardiogram, more pronounced changes in indicators of general and biochemical blood tests. In the second variant, pneumonia was tolerated by children more easily, was characterized by less pronounced symptoms of intoxication, inhibited by hyperthermia, but patients had positive PCR tests for SARS-CoV-2 longer. Our study did not establish the relationship between the pneumonia variant and the age and gender of the patients, but there may be a need for further research.