Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study
Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study
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DOI：
10.1016/s1473-3099(20)30198-5
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发表时间：
2020-06-01
影响因子：
56.3
通讯作者：
Chen, Dong
中科院分区：
文献类型：
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作者：
Qiu, Haiyan;Wu, Junhua;Chen, Dong
自2019年12月以来，2019冠状病毒病（COVID-19）疫情在全球蔓延。目前对小儿COVID-19患者的流行病学和临床特征知之甚少。方法回顾性检索浙江省三家医院电子病历中确诊的儿童COVID-19患者（0-16岁）的资料。我们记录了患者的流行病学和临床特征。结果2020年1月17日至3月1日，共发现36例儿童感染严重急性呼吸综合征冠状病毒2，平均年龄8.3 [SD 3.5]岁。传播途径为家庭成员密切接触（32例[89%]）或有疫区暴露史（12例[33%]）；8例（22%）患者同时有两种暴露。中度临床型肺炎19例（53%）；17例（47%）临床症状轻，无症状（10例[28%]）或有急性上呼吸道症状（7例[19%]）。入院时常见症状为发热（13例[36%]）和干咳（7例[19%]）。在发热的患者中，4例（11%）体温为38.5℃或更高，9例（25%）体温为37.5-38.5℃。典型的实验室异常表现为肌酸激酶MB升高（11例[31%]），淋巴细胞减少（11例[31%]），白细胞减少（7例[19%]），降钙素原升高（6例[17%]）。除影像学表现外，与COVID-19严重程度显著相关的变量包括淋巴细胞减少、体温升高、降钙素原、d -二聚体和肌酸激酶MB水平高。所有儿童均接受每日两次的α干扰素雾化治疗，14名（39%）接受每日两次的洛匹那韦-利托那韦糖浆治疗，6名（17%）需要吸氧。平均住院时间14天（SD 3）。截至2020年2月28日，患者全部治愈。虽然本组患儿均为轻、中度新冠肺炎，但无症状儿童的比例较大，表明在没有明确流行病学信息的情况下，难以识别儿科患者，导致社区获得性感染的危险局面。
Background Since December, 2019, an outbreak of coronavirus disease 2019 (COVID-19) has spread globally. Little is known about the epidemiological and clinical features of paediatric patients with COVID-19.Methods We retrospectively retrieved data for paediatric patients (aged 0-16 years) with confirmed COVID-19 from electronic medical records in three hospitals in Zhejiang, China. We recorded patients' epidemiological and clinical features.Findings From Jan 17 to March 1, 2020, 36 children (mean age 8.3 [SD 3.5] years) were identified to be infected with severe acute respiratory syndrome coronavirus 2. The route of transmission was by close contact with family members (32 [89%]) or a history of exposure to the epidemic area (12 [33%]); eight (22%) patients had both exposures. 19 (53%) patients had moderate clinical type with pneumonia; 17 (47%) had mild clinical type and either were asymptomatic (ten [28%]) or had acute upper respiratory symptoms (seven [19%]). Common symptoms on admission were fever (13 [36%]) and dry cough (seven [19%]). Of those with fever, four (11%) had a body temperature of 38.5 degrees C or higher, and nine (25%) had a body temperature of 37.5-38.5 degrees C. Typical abnormal laboratory findings were elevated creatine kinase MB (11 [31%]), decreased lymphocytes (11 [31%]), leucopenia (seven [19%]), and elevated procalcitonin (six [17%]). Besides radiographic presentations, variables that were associated significantly with severity of COVID-19 were decreased lymphocytes, elevated body temperature, and high levels of procalcitonin, D-dimer, and creatine kinase MB. All children received interferon alfa by aerosolisation twice a day, 14 (39%) received lopinavir-ritonavir syrup twice a day, and six (17%) needed oxygen inhalation. Mean time in hospital was 14 (SD 3) days. By Feb 28, 2020, all patients were cured.Interpretation Although all paediatric patients in our cohort had mild or moderate type of COVID-19, the large proportion of asymptomatic children indicates the difficulty in identifying paediatric patients who do not have clear epidemiological information, leading to a dangerous situation in community-acquired infections.