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Clinical and Epidemiological Assessment of Children and Adolescents Hospitalized with SARS-CoV-2 in the Pre-Amazon
Marilene Ribeiro1,2, Luis Sousa3,4, Johnatha Oliveira5
1Postgraduate Program in Management of Health Programs and Services, Campus Renascença, CEUMA University, São Luís 65075-120, Brazil.
Insights
COVID-19 in children is typically mild, but pediatric multisystem inflammatory syndrome (PMIS) presents a severe risk. Rapid diagnosis is crucial to guide treatment and avoid unnecessary antibiotic use in pediatric respiratory infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- COVID-19 in children and adolescents often mimics other respiratory viral infections.
- Pediatric COVID-19 cases, particularly pneumonia, are underrepresented in existing literature.
- Children and adolescents generally exhibit lower infection rates and milder disease compared to adults.
Purpose of the Study:
- To investigate the clinical and epidemiological characteristics of hospitalized pediatric patients with SARS-CoV-2.
- To analyze COVID-19 outcomes in children and adolescents in a specific Brazilian region.
Main Methods:
- Retrospective analysis of medical records from March 2020 to March 2021.
- Inclusion criteria: patients aged 0-13 years with community-acquired pneumonia diagnosis.
- Study conducted across four public hospitals in São Luís, Brazil.
Main Results:
- The most affected age group was 1-5 years (approx. 40%).
- Fever was present in 78.6% of pediatric COVID-19 cases; chronic neurological disease was the most common comorbidity.
- Ground glass opacity was noted in 24.8% of cases; 17 patients were diagnosed with pediatric multisystem inflammatory syndrome (PMIS), and 18 patients died.
Conclusions:
- While SARS-CoV-2 infection is generally mild in pediatric populations, PMIS cases are severe and can be fatal.
- Increased inflammatory biomarkers are associated with severe COVID-19 and PMIS in children.
- The study highlights the need for accurate diagnosis to optimize therapeutic decisions and reduce indiscriminate antibiotic use.
Introduction:
SARS-CoV-2 infection usually presents similarly to other respiratory viral pathogens. Children and adolescents do not present as a group that is highly affected by the disease, having low infection rates. However, limited publications are associated with the findings of pneumonia in pediatric patients with COVID-19.
Objective:
To analyze the clinical and epidemiological aspects of children and adolescents hospitalized with SARS-CoV-2 in a pre-Amazon region.
Methods:
A retrospective study, carried out in four public hospitals in São Luís, Brazil where medical records of children and adolescents aged from 0 to 13 years, of both sexes, with clinical diagnosis of community-acquired pneumonia were evaluated from March 2020 to March 2021.
Results:
Almost 40.0% of children were aged between 1 year and 5 years. Of the 128 children who had SARS-CoV-2, 3 are of indigenous ethnicity. Additionally, 78.6% of the children had fever and there was no significant difference between COVID-19 patients and those of other respiratory viruses. Eighteen patients had chronic neurological disease, which is the most common comorbidity observed in patients with coronavirus infection. Ground glass opacity attenuation was observed in 24.8% of children and adolescents with COVID-19. Anemia and increased inflammatory response markers were related to SARS-CoV-2 infection. More than 90.0% of patients admitted to hospital, regardless of etiology, were treated with antibiotics. Eighteen patients died. Pediatric multisystem inflammatory syndrome (PMIS) was diagnosed in 17 patients.
Conclusions:
SARS-CoV-2 in children and adolescents is mild, but the condition of patients with PMIS is more serious, with an increase in inflammatory biomarkers which can lead to death. Therefore, rapid diagnosis and differentiation of agents causing respiratory diseases are necessary for better therapeutic decision making, since the results of this study make us question the excessive use of antibiotics without meeting well-defined clinical-epidemiological criteria.
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