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Clinical characteristics of COVID-19 in children: a large multicenter study from Iran
Azin Hajialibeig1, Mohammad Reza Navaeifar1, Amir-Hassan Bordbari2
1Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Insights
Pediatric COVID-19 cases, while often mild, carry risks due to delayed vaccination. Underlying conditions, obesity, and gastrointestinal issues significantly increase the likelihood of intensive care unit (ICU) admission in children.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Critical care medicine
Background:
- Pediatric COVID-19 typically presents with milder symptoms and lower mortality compared to adults.
- Delayed pediatric vaccination during the pandemic increased risks for children.
- Understanding disease severity and risk factors in pediatric COVID-19 is crucial for effective management.
Purpose of the Study:
- To analyze demographic characteristics, clinical features, and disease severity in pediatric COVID-19 patients in Iran.
- To identify risk factors associated with intensive care unit (ICU) admission and severe outcomes in children with COVID-19.
- To provide data to inform vaccination strategies and targeted interventions for vulnerable pediatric populations.
Main Methods:
- An observational, multicenter study involving 1,031 children (0-21 years) diagnosed with COVID-19 in Iran.
- Patients were classified into mild, moderate, severe, or critical categories based on clinical and radiographic findings.
- Logistic regression analysis was used to determine factors linked to ICU admission and disease severity.
Main Results:
- Fever, cough, and dyspnea were the most common symptoms. 19.77% of inpatients required ICU admission, with a 0.91% mortality rate.
- Children with underlying diseases, gastrointestinal symptoms, and obesity showed significantly higher odds of ICU admission.
- Age distribution varied across severity groups, with over half of cases occurring in children over 5 years old.
Conclusions:
- While pediatric COVID-19 mortality is low, certain factors like comorbidities, obesity, and GI symptoms are critical predictors of severe disease and ICU admission.
- Early recognition of symptoms and risk factors is vital for timely intervention in pediatric COVID-19 cases.
- Vaccination and targeted public health measures are essential to protect children and reduce the burden on healthcare systems.
Introduction:
During the COVID-19 pandemic, pediatric cases typically exhibit milder symptoms and lower mortality rates. However, the delay in pediatric vaccination poses major risks for children. This multicenter study aimed to comprehensively analyze demographic characteristics, clinical features, disease severity, and risk factors for ICU admission in Iran.
Materials And Methods:
This observational study enrolled children aged 0-21 years with confirmed or probable COVID-19 diagnoses, referred from selected hospitals across 17 counties in Mazandaran province, Iran, between February 19 and August 14, 2021. Patients were categorized into mild, moderate, severe, or critical cases based on clinical and radiographic criteria. Data were extracted from medical records and analyzed using statistical methods. Logistic regression analysis was performed to identify factors associated with ICU admission and disease severity.
Results:
Among the 1,031 children included in the study, 61 were diagnosed with MIS-C. The distribution of patients by severity was 156 mild, 671 moderate, and 204 severe/critical cases. Age distribution significantly differed across severity groups (P < 0.001), with 55.19% aged over 5 years and 54% being male. 11.44% had underlying diseases. Fever (71.97%) was the most common symptom, followed by cough (34.43%) and dyspnea (24.83%). Within the inpatient group, 19.77% required ICU admission, with 0.91% mortality, including 3 MIS-C cases. Children with underlying diseases, gastrointestinal symptoms, and obesity had 4.16, 3.10-, and 2.17-times higher likelihood of ICU admission, respectively.
Conclusion:
Our study emphasized the importance of recognizing pediatric COVID-19 severity and symptoms. While fever, cough, and dyspnea prevailed, mortality rates were relatively low. However, comorbidities, obesity, and gastrointestinal symptoms linked to ICU admission, stressing early intervention. BMI also impacted disease severity and admission rate. Vaccination and targeted interventions are essential for protecting vulnerable children and easing healthcare strain.
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