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Coronavirus disease in children: A multicentre study from the Kingdom of Saudi Arabia
Jameela A Kari1, Mohamed A Shalaby1, Amr S Albanna2
1Paediatric Nephrology Centre of Excellence, Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
Insights
Most hospitalized children with COVID-19 experienced mild illness and recovered fully. However, a small percentage developed severe disease, requiring intensive care and presenting specific risk factors for mortality and prolonged hospitalization.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- The COVID-19 pandemic necessitated understanding its impact on pediatric populations.
- Children generally exhibit milder COVID-19 symptoms, but some develop severe multisystem inflammatory syndrome.
- This study investigates COVID-19 characteristics in hospitalized children in Saudi Arabia.
Purpose of the Study:
- To characterize COVID-19 in hospitalized children under 15.
- To identify risk factors for mortality, morbidity, and pediatric intensive care unit (PICU) admission.
- To assess clinical presentation and outcomes in pediatric COVID-19 cases.
Main Methods:
- Retrospective analysis of 88 pediatric COVID-19 patients hospitalized between March and June 2020.
- Data collected from three tertiary academic hospitals in Saudi Arabia.
- Assessment of clinical presentation, laboratory results, and outcomes.
Main Results:
- Most children (97.7%) tested positive for COVID-19 on initial PCR.
- 8% of patients required PICU admission, with 4.5% mortality, often linked to multisystem inflammatory syndrome.
- Risk factors for mortality included hypotension, hypoxia, and specific lab abnormalities; comorbidities increased prolonged hospitalization risk.
Conclusions:
- The majority of hospitalized children recovered from a brief febrile illness.
- A minority experienced severe COVID-19 disease with significant morbidity and mortality risks.
- Identifying risk factors is crucial for managing severe pediatric COVID-19 cases.
Background:
The COVID-19 global pandemic caused by severe acute respiratory syndrome coronavirus 2 infection, warranted attention for whether it has unique manifestations in children. Children tend to develop less severe disease with a small percentage present with clinical manifestations of paediatric multisystem inflammatory syndrome and have poor prognosis. We studied the characteristics of COVID-19 in children requiring hospitalisation in the Kingdom of Saudi Arabia and assessed the clinical presentation and the risk factors for mortality, morbidity, and paediatric intensive care (PICU) admission.
Methods:
We conducted a retrospective analysis of COVID-19 patients under 15 years hospitalised at three tertiary academic hospitals between 1 March and 30 June 2020.
Results:
Eighty-eight children were enrolled (>20% were infants). Seven (8%) were in critical condition and required PICU admission, and 4 (4.5%) died of which 3 met the full diagnostic criteria of multi-system inflammatory syndrome and had a high Paediatric Risk of Mortality (PRISM) score at the time of admission. The initial polymerase chain reaction (PCR) test result was positive for COVID-19 in most patients (97.7%), and the remaining two patients had positive result in the repeated confirmatory test. In a subset of patients (20 subjects), repeated PCR testing was performed until conversion to negative result, and the average duration for conversion was 8 (95% CI: 5.2-10.5) days Children requiring PICU admission presented with signs of respiratory distress, dehydration, and heart failure. Most had fever (71.4%) and tonsillitis; 61.4% were discharged within 7 days of hospitalisation. Risk factors for mortality included skin rash, hypotension, hypoxia, signs of heart failure, chest radiograph suggestive of acute respiratory distress syndrome, anaemia, leucocytosis, hypernatraemia, abnormal liver enzymes, and high troponin I, and risk factors for prolonged hospitalisation (>7 days) included the presence of comorbidities, leucopaenia, hyponatraemia, and elevated C-reactive protein.
Conclusions:
The majority of hospitalised children had a brief febrile illness and made a full recovery, but a minority had severe disease.
