New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region. Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.

Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4-82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7 ±1.0 vs. 1.1 ± 0.5 respectively; р < 0.001). The mean age of the hospitalized children was 8 years (7.4-9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3-83.0), cough (66.1%; 95% CI 57.1-74.4]), fatigues (38.7%; 95% CI 30.1-47.9), and hyposmia (33.9%; 95% CI 25.6-42.9). The severe disease course was rare (2.4%; 95% CI 0.5-6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р < 0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide / fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of > 5 days duration can be a predictor of pneumonia in a pediatric patient with COVID-1 9 (odds ratio 4.55 (2.1-9.9), sensitivity 61.4%, specificity 74.1%).

Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-1 9.