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Clinical features and disease severity across immune status in pediatric patients with COVID-19
Nawaf Mohammed Al-Dajani1, Mona Ahmed Bahasan2, Maha Abdullah Alzubed3
1From the Pediatric Infectious Diseases, King Abdullah University, Jeddah, Saudi Arabia.
Insights
Pediatric COVID-19 outcomes were similar between immunocompetent and immunocompromised children. Immunocompromised children had higher hospitalization rates, likely due to precautionary admissions rather than increased disease severity.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted global health, with varied presentations in children based on immune status.
- Understanding these differences is crucial for effective pediatric care during the pandemic.
Purpose of the Study:
- To compare clinical presentation, disease course, and outcomes of immunocompetent versus immunocompromised pediatric patients with COVID-19.
- Study conducted at a tertiary referral hospital in Jeddah, Saudi Arabia.
Main Methods:
- Retrospective chart review of 123 pediatric patients (<15 years) with confirmed COVID-19 (March 2020-March 2021).
- Compared demographic, clinical, laboratory, and treatment variables between immunocompetent and immunocompromised groups.
- Immunocompromised status defined by underlying conditions or treatments causing immune suppression.
Main Results:
- Fever was more common in immunocompetent children (P=.029).
- Immunocompromised children had higher admission rates, often for non-COVID-related issues.
- Recovery rates were similar between groups (P=.568), with most patients recovering without complications.
Conclusions:
- COVID-19 severity and recovery were comparable between immunocompetent and immunocompromised pediatric patients in this cohort.
- Higher hospitalization in immunocompromised children may reflect admission practices, not necessarily disease severity.
- Larger multicenter studies are needed due to small sample size and study design limitations.
Background:
COVID-19 pandemic has caused a major global health disruption. Pediatric presentations vary widely, particularly among children with differing immune status.
Objectives:
To compare the clinical presentation, disease course, and outcomes of immunocompetent versus immunocompromised pediatric patients with COVID-19 in a tertiary referral hospital in Jeddah, Saudi Arabia.
Design:
Retrospective chart review.
Settings:
A tertiary center treating immunocompromised children including those with HIV, solid and hematologic malignancies, and solid organ or hematopoietic stem cell transplantation.
Patients And Methods:
Records of 123 pediatric patients (<15 years) with confirmed COVID-19 from March 2020 to March 2021 were reviewed. Demographic, clinical, laboratory, radiologic, and treatment variables were extracted and compared between immunocompetent and immunocompromised patients. Chi-square testing was used with significance set at P<.05. Immunocompromised status was defined as the presence of an underlying medical condition or treatment associated with clinically significant immune suppression.
Main Outcome Measures:
Differences in symptoms, severity, clinical progression, and outcomes between immunocompetent and immunocompromised children.
Sample Size:
123 children.
Results:
Most patients were immunocompetent (93, 75.6%). Immunocompromised children primarily included post-transplant or oncology patients on chemotherapy. Fever was the most common presenting symptom (69, 56.1%), significantly more common in immunocompetent children (P=.029). Immunocompromised children were more frequently admitted, mainly for non-COVID-related concerns (e.g., abnormal chest radiograph, febrile neutropenia, or hydration). Nearly all patients recovered without complications, and no significant difference in recovery rate was observed between groups (P=.568).
Conclusion:
COVID-19 severity and recovery appeared similar between immunocompetent and immunocompromised pediatric patients in this cohort. However, the higher hospitalization rate observed among immunocompromised children likely reflects precautionary admission practices rather than increased disease severity. Findings should be interpreted cautiously given the small immunocompromised subgroup and heterogeneity of underlying conditions. Interpretation of these findings is limited by the retrospective design and relatively small sample size. Larger multicenter studies are required to confirm these observations.
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