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1. Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
Marques, Heloisa Helena de Sousa ; Pereira, Maria Fernanda Badue ; Santos, Angélica Carreira dos ; Fink, Thais Toledo ; Paula, Camila Sanson Yoshino de ; Litvinov, Nadia ; Schvartsman, Claudio ; Delgado, Artur Figueiredo ; Gibelli, Maria Augusta Bento Cicaroni ; Carvalho, Werther Brunow de ; Odone Filho, Vicente ; Tannuri, Uenis ; Carneiro-Sampaio, Magda ; Grisi, Sandra ; Duarte, Alberto José da Silva ; Antonangelo, Leila ; Francisco, Rossana Pucineli Vieira ; Okay, Thelma Suely ; Batisttella, Linamara Rizzo ; Carvalho, Carlos Roberto Ribeiro de ; Brentani, Alexandra Valéria Maria ; Silva, Clovis Artur ; Eisencraft, Adriana Pasmanik ; Rossi Junior, Alfio ; Fante, Alice Lima ; Cora, Aline Pivetta ; Reis, Amelia Gorete A. de Costa ; Ferrer, Ana Paula Scoleze ; Andrade, Anarella Penha Meirelles de ; Watanabe, Andreia ; Gonçalves, Angelina Maria Freire ; Waetge, Aurora Rosaria Pagliara ; Silva, Camila Altenfelder ; Ceneviva, Carina ; Lazari, Carolina dos Santos ; Abellan, Deipara Monteiro ; Santos, Emilly Henrique dos ; Sabino, Ester Cerdeira ; Bianchini, Fabíola Roberta Marim ; Alcantara, Flávio Ferraz de Paes ; Ramos, Gabriel Frizzo ; Leal, Gabriela Nunes ; Rodriguez, Isadora Souza ; Pinho, João Renato Rebello ; Carneiro, Jorge David Avaizoglou ; Paz, Jose Albino ; Ferreira, Juliana Carvalho ; Ferranti, Juliana Ferreira ; Ferreira, Juliana de Oliveira Achili ; Framil, Juliana Valéria de Souza ; Silva, Katia Regina da ; Kanunfre, Kelly Aparecida ; Bastos, Karina Lucio de Medeiros ; Galleti, Karine Vusberg ; Cristofani, Lilian Maria ; Suzuki, Lisa ; Campos, Lucia Maria Arruda ; Perondi, Maria Beatriz de Moliterno ; Diniz, Maria de Fatima Rodrigues ; Fonseca, Maria Fernanda Mota ; Cordon, Mariana Nutti de Almeida ; Pissolato, Mariana ; Peres, Marina Silva ; Garanito, Marlene Pereira ; Imamura, Marta ; Dorna, Mayra de Barros ; Luglio, Michele ; Rocha, Mussya Cisotto ; Aikawa, Nadia Emi ; Degaspare, Natalia Viu ; Sakita, Neusa Keico ; Udsen, Nicole Lee ; Scudeller, Paula Gobi ; Gaiolla, Paula Vieira de Vincenzi ; Severini, Rafael da Silva Giannasi ; Rodrigues, Regina Maria ; Toma, Ricardo Katsuya ; Paula, Ricardo Iunis Citrangulo de ; Palmeira, Patricia ; Forsait, Silvana ; Farhat, Sylvia Costa Lima ; Sakano, Tânia Miyuki Shimoda ; Koch, Vera Hermina Kalika ; Cobello Junior, Vilson .
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
2. Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome
Pereira, Maria Fernanda Badue ; Litvinov, Nadia ; Farhat, Sylvia Costa Lima ; Eisencraft, Adriana Pasmanik ; Gibelli, Maria Augusta Bento Cicaroni ; Carvalho, Werther Brunow de ; Fernandes, Vinicius Rodrigues ; Fink, Thais de Toledo ; Framil, Juliana Valéria de Souza ; Galleti, Karine Vusberg ; Fante, Alice Lima ; Fonseca, Maria Fernanda Mota ; Watanabe, Andreia ; Paula, Camila Sanson Yoshino de ; Palandri, Giovanna Gavros ; Leal, Gabriela Nunes ; Diniz, Maria de Fatima Rodrigues ; Pinho, João Renato Rebello ; Silva, Clovis Artur ; Marques, Heloisa Helena de Sousa ; Rossi Junior, Alfio ; Delgado, Artur Figueiredo ; Andrade, Anarella Penha Meirelles de ; Schvartsman, Claudio ; Sabino, Ester Cerdeira ; Rocha, Mussya Cisotto ; Kanunfre, Kelly Aparecida ; Okay, Thelma Suely ; Carneiro-Sampaio, Magda Maria Sales ; Jorge, Patricia Palmeira Daenekas .
OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.
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