Background As of April 18, 2020, over 2,000,000 patients had been diagnosed with coronavirus disease-2019 (COVID-19) globally, and more than 140,000 deaths had been reported. The clinical and epidemiological characteristics of adult patients have been documented recently. However, information on pediatric patients is limited. We describe the clinical and epidemiological characteristics of pediatric patients to provide valuable insight into the early diagnosis and assessment of COVID-19 in children. Methods and findings This retrospective, observational study involves a case series performed at 4 hospitals in West China. Thirty-four pediatric patients with COVID-19 were included from January 27 to February 23, 2020. The final follow-up visit was completed by March 16, 2020. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, radiological findings, and treatment information. Data analysis was performed for 34 pediatrics patients with COVID-19 aged from 1 to 144 months (median 33.00, interquartile range 10.00–94.25), among whom 14 males (41%) were included. All the patients in the current study presented mild (18%) or moderate (82%) forms of COVID-19. A total of 48% of patients were noted to be without a history of exposure to an identified source. Mixed infections of other respiratory pathogens were reported in 16 patients (47%). Comorbidities were reported in 6 patients (18%). The most common initial symptoms were fever (76%) and cough (62%). Expectoration (21%), vomiting (12%), and diarrhea (12%) were also reported in a considerable portion of cases. A substantial increase was detected in serum amyloid A for 17 patients (among 20 patients with available data; 85%) and in high-sensitivity C-reactive protein for 17 patients (among 29 patients with available data; 59%), whereas a decrease in prealbumin was noticed in 25 patients (among 32 patients with available data; 78%). In addition, significant increases in the levels of lactate dehydrogenase and α-hydroxybutyrate dehydrogenase were detected in 28 patients (among 34 patients with available data; 82%) and 25 patients (among 34 patients with available data; 74%), respectively. Patchy lesions in lobules were detected by chest computed tomographic scans in 28 patients (82%). Ground-glass opacities, which were a typical feature in adults, were rare in pediatric patients (3%). Rapid radiologic progression and a late-onset pattern of lesions in the lobules were also noticed. Lesions in lobules still existed in 24 (among 32 patients with lesions; 75%) patients that were discharged, although the main symptoms disappeared a few days after treatment. All patients were discharged, and the median duration of hospitalization was 10.00 (8.00–14.25) days. The current study was limited by the small sample size and a lack of dynamic detection of inflammatory markers. Conclusions Our data systemically presented the clinical and epidemiological features, as well as the outcomes, of pediatric patients with COVID-19. Stratified analysis was performed between mild and moderate cases. The findings offer new insight into early identification and intervention in pediatric patients with COVID-19. Che Zhang and colleagues report on a series of children with SARS-CoV-2 infection in China. Author summary Why was this study done? Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly worldwide. Early identification and intervention are necessary for effective control of the epidemic in both adults and children; however, the information on clinical and epidemiological characteristics in pediatric patients was limited. What did the researchers do and find? We collected and analyzed the clinical data of 34 pediatric patients with coronavirus disease-2019 (COVID-19) in 4 hospitals in China from January 27 to February 23, 2020. We described the clinical and epidemiological characteristics of the patients and focused on the features of initial symptoms, radiological findings, and outcomes. In contrast to that observed in adult patients, higher proportion of fever, vomiting, and diarrhea were noticed on admission in pediatric cases. Patchy shadows with a high density were common in lobule lesions, whereas the typical features of ground-glass opacities seen in adults were rare in pediatric cases. A late-onset pattern of lobule lesions was revealed on the basis of chest computed tomographic scans. The clinical presentations were not as severe as the signs observed in the computed tomography (CT) images, and the recovery of lesions in lobules lagged behind that of the main symptoms. What do these findings mean? The specific clinical features in pediatric patients should be given more attention when physicians are dealing with suspected cases. No direct evidence was found in our study regarding the transmission from children to adults. However, the risk of family cluster transmission from children harboring virus and the impact to community-based epidemic prevention should be taken into consideration in policy making for epidemic control. With respect to the underlying reasons for the decreased risk of the severe form of COVID-19 in children, mixed infection did not increase protection to ameliorate the disease course of COVID-19 based on our data.
【초록키워드】 COVID-19, Treatment, SARS-CoV-2, coronavirus, SARS-COV-2 infection, children, hospital, Infection, inflammatory markers, risk, Laboratory tests, Intervention, Transmission, Symptom, progression, cough, diarrhea, virus, lactate dehydrogenase, Symptoms, Spread, China, outcomes, Computed tomography, early diagnosis, ground-glass opacity, Adults, Epidemic, Characteristics, Features, clinical, Fever, male, Patient, death, Rapid, Cluster, Mild, epidemiological, Follow-up, information, Admission, moderate, patients, clinical feature, Evidence, retrospective, Analysis, clinical presentation, initial symptoms, initial symptom, lesion, mixed infection, interquartile range, High-sensitivity C-reactive protein, acute respiratory syndrome, Pediatric patient, Clinical data, respiratory pathogen, lesions, demographic data, expectoration, serum amyloid, Final, small sample size, West, vomiting, physician, offer, pediatric cases, researcher, α-Hydroxybutyrate dehydrogenase, duration of hospitalization, feature, effective, decrease, radiological, the epidemic, Course, described, analyzed, performed, radiologic, lack, collected, proportion, reported, the patient, addition, diagnosed, the disease, form, was performed, case sery, median, discharged, systemically, significant increases in, All the patient, chest computed tomographic, patients with COVID-19, the median, with COVID-19, 【제목키워드】 SARS-COV-2 infection, pediatric, Characteristics, clinical, epidemiological, multicenter, case sery,