Characteristics of CoVID-19 in children: the first experience in the hospital of st. Petersburg

Abstract

Objective:to identify the clinical, laboratory and epidemiological features of the new coronavirus (CV) infection inthe provision of specialized medical care to children in themegalopolis of the Russian Federation.Methods:674 cases of hospitalization of patients frombirth to 17 years old inclusive with confirmed COVID-19 inthe period from March 26 to June 26, 2020 in a children’smultidisciplinary hospital in St. Petersburg. Diagnostics ofSARS-COV-2 in upper respiratory tract (URT) smears wascarried out by PCR (a set of reagents for detecting RNA ofcoronavirus 2019-nCoV by PCR with hybridization-fluorescence detection “Vector-PCRRV-2019-nCoV-RG”). Patientsunderwent 4 (3; 5) repeated examinations depending on thediagnosis of the referral, as well as the duration of the convalescent virus carriage. The analysis of the severity of thecourse of the disease, the main clinical manifestations andtheir relationship with the development of pneumonia, as wellas the epidemiological features of COVID-19 in children. Theduration of inpatient treatment, outcomes and the need forintensive care are described. Changes in a number of laboratory parameters on analyzers made in the USA were assessed:a clinical blood test on a hematological one - Coulter UniCel(Beckman Coulter), a biochemical blood test on a biochemical one - Uni Cel DxC (Beckman Coulter), a coagulogram ona hemostasis analyzer (Instrumentation Laboratory).Results:Overall, there was a favorable course ofCOVID-19 in children. Intensive therapy was required only in3.6% of cases with a total mortality rate of 0.15%, Kawasakilike syndrome was recorded in 0.3% of cases. In 1/3 of patients, prolonged viral shedding from the upper respiratorytract was detected. In children, intrafamilial infection fromadults was in the lead; schoolchildren accounted for half ofall hospitalizations. A distinctive feature of the new infectionwas mild clinical symptoms with fever and catarrhal symptoms up to 4/5 of cases, gastrointestinal symptoms - in every third patient. There were no significant differences in the severity of the disease by age. Pneumonia, diagnosed in ¾cases by computed tomography, complicated the course in13.1% of cases. The defeat of the lungs was accompanied byfever and dry cough, and in a more severe course: desaturation, chest pains, a feeling of insufficiency of inspiration. Theage peaks of the incidence of pneumonia were revealed: at4, 9, 12 years old and at the age of 17 years, the maximum(in 1/3 of cases). Laboratory changes were insignificant andquickly reversible.Conclusion:the course of COVID-19 in children in themegalopolis of Russia is comparable with foreign information. However, taking into account the experience of “Spanish ‘flu”, it is possible that in pediatric practice the numberof severe forms and unfavorable outcomes may change inthe near future, especially due to the difficulty of diagnosingKawasaki-like syndrome and the need for a multidisciplinaryapproach to the treatment of such patients. Currently, themost vulnerable to the new CV are children with severe oncological, neurological and cardiovascular pathology, whohave a rapid decompensation of the underlying diseaseagainst the background of COVID-19.