Most COVID-19 studies have focused on adults, and the understanding of exactly how the novel coronavirus affects children is limited, according to new research.

An international study group recently sought to characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among 242,158 children and adolescents diagnosed or hospitalized with coronavirus disease 2019 (COVID-19) and 9,769 who ended up hospitalized. A secondary analysis also compared patients with a group of more than 2 million infected in previous seasonal influenza in 2017–2018. Results were published in the journal Pediatrics.

Researchers point out that comorbidities including neurodevelopmental disorders, heart disease, and cancer were more common among youngsters who had to be admitted compared to the general group diagnosed with COVID-19. “Hospitalization was observed in 0.3% to 1.3% of the cohort diagnosed with COVID-19, with undetectable (n < 5 per database) 30-day fatality,” they write.

The study team determined that dyspnea, bronchiolitis, anosmia, and gastrointestinal symptoms were more common in COVID-19 than influenza and that 30-day outcomes including pneumonia and hypoxemia were more frequent in COVID-19 than influenza.

The study also describes prevalent in-hospital treatments for COVID-19, including repurposed medications (<10%) and adjunctive therapies:
• Systemic corticosteroids (6.8%-7.6%)
• Famotidine (9.0%-28.1%)
• Antithrombotics such as aspirin (2.0%-21.4%), heparin (2.2%-18.1%), and enoxaparin (2.8%-14.8%)

Overall, the study concludes, “Clinical manifestations of COVID-19 are generally milder in the pediatric population compared with adults, and hospitalization for COVID-19 affects mostly children with preexisting comorbidities.”

“With this study, we comprehensively report on the largest cohort of children and adolescents with COVID-19 to date,” the authors write. “Overall, most cases of COVID-19 diagnosis and related hospitalizations were seen among infants and toddlers aged <4 years, predominantly of male sex. Children and adolescents hospitalized with COVID-19 had a higher prevalence of comorbidities than the overall cohort of those diagnosed with COVID-19, including asthma, obesity, heart disease, cancer, chromosomal disorder(s), and congenital malformation(s). The most commonly observed symptoms were fever and cough, whereas dyspnea, bronchiolitis, anosmia, and gastrointestinal tract symptoms were more common in children and adolescents with COVID-19 than with seasonal influenza and may aid on the differentiation of COVID-19 from other viral infections.”

The study also emphasizes that hospitalization rates “were between fivefold and 13-fold higher among those children and adolescents diagnosed with COVID-19 versus those with seasonal influenza in previous years. Fortunately, the 30-day fatality rate after a COVID-19 diagnosis or hospitalization was low. Respiratory complications were overrepresented among children and adolescents diagnosed with COVID-19 compared with seasonal influenza.”

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