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Emergency department evaluation of transplanted children with COVID-19
Sagrario Barreiro Pérez1, Miguel Ángel Molina Gutiérrez2, Valeria Antoñanzas Bernar3
1Pediatric Department, La Paz University Hospital, P° Castellana, 261, 28046 Madrid, Spain.
Insights
Pediatric solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients generally experienced favorable outcomes after SARS-CoV-2 infection. Most children presented with fever, and hospitalization occurred in 41.9% with no reported deaths.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Transplant Surgery
Background:
- Children typically have mild SARS-CoV-2 (COVID-19) infections.
- Immunocompromised pediatric patients, including those with solid organ transplants (SOT) and hematopoietic stem cell transplants (HSCT), may exhibit different disease courses.
- Understanding COVID-19 manifestations in these vulnerable pediatric populations is crucial.
Purpose of the Study:
- To describe the clinical, laboratory, and radiologic features of pediatric SOT and HSCT recipients diagnosed with SARS-CoV-2.
- To assess the outcomes of COVID-19 in this specific pediatric cohort.
Main Methods:
- A multicenter retrospective observational study was conducted in Madrid, Spain, from March 2020 to December 2022.
- Included were pediatric patients (0-18 years) with positive SARS-CoV-2 tests from emergency departments.
- Data collected included clinical symptoms, laboratory results, and radiological findings.
Main Results:
- Thirty-one pediatric SOT/HSCT patients were analyzed; only one was asymptomatic.
- Fever was the most common symptom (76.7%), and 12 patients had abnormal chest X-rays (66.6%).
- Hospitalization occurred in 41.9% of patients, with no deaths reported, irrespective of transplant type or immunosuppression status.
Conclusions:
- The clinical course and outcomes of COVID-19 in pediatric SOT and HSCT patients were generally favorable.
- These findings highlight the importance of monitoring SARS-CoV-2 in immunocompromised children.
- Further research may explore specific management strategies for this population.
Background:
Children usually have an asymptomatic or mild course of SARS-CoV-2 infection, studies in immunocompromised patients have shown a different evolution. The aim of this study was to describe the clinical, laboratory, and radiologic manifestations of pediatric solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients testing positive for SARS-CoV-2.
Methods:
A multicenter retrospective, observational descriptive study was conducted in 3 tertiary hospitals in Madrid (Spain) between March 2020 and December 2022. Consecutive patients aged 0-18 attending the corresponding pediatric emergency departments with a positive result in the real-time polymerase chain reaction test or antigenic test to detect SARS-CoV-2 in the nasopharyngeal sample were included.
Results:
A total of 31 children were included in the study. Sixteen (51.6%) were patients with HSCT and 15 (48.3) were patients with SOT. The median time from transplantation to COVID-19 was 1.2 years (IQR:0.5-5.1). The SOT cohort included liver (n = 4, 12.9%), kidney (n = 4, 12.9%), heart (n = 3, 9.7%), multivisceral (n = 3, 9.7%), and lung (n = 1, 3.2%). Of the 31 patients, only one was asymptomatic. The most common symptom on presentation was fever (76.7%). Abnormalities were seen on chest X-ray in 8 (66.6%) of the 12 patients. There was no significant difference in clinical manifestations, lymphopenia and radiological findings regardless of the type of transplantation or immunosuppression status. Thirteen patients (41.9%) were hospitalized. There were no patient deaths.
Conclusions:
In our study, we found that the clinical course and outcome of SOT and HSCT pediatric patients with COVID-19 were generally favorable.
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