Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

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Olivia Swann1,2, Karl Holden3,4, Lance Turtle5,6, Louisa Pollock7, Cameron J Fairfield8, Thomas M Drake8, Sohan Seth9, Conor Egan9, Hayley Hardwick6, Sophie Halpin10, Michelle Girvan10, Chloe Donohue10, Mark Peters11, Latifa Patel12, Shamez Ladhani13,14, Louise Sigfrid15, Ian Sinha12,4, Piero Olliaro15, Jonathan S. Nguyen‐Van‐Tam16,17, Peter Horby15, Laura Merson15, Gail Carson15, Jake Dunning18,19, Peter Openshaw18, J. Kenneth Baillie20,21, Ewen M Harrison8, Annemarie B Docherty8,20, Malcolm G. Semple6,3
1; Department of Child Life and Health; University of Edinburgh; Edinburgh UK
2Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK
3Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
4Women's and Children's Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
5Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
6Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
7Paediatric Infectious Diseases, Royal Hospital for Children, Glasgow, UK
8Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
9Institute for Adaptive and Neural Computation, School of Informatics, University of Edinburgh, UK
10Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
11Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
12Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
13Immunisation and Countermeasures Division, Public Health England, Colindale, UK
14Paediatric Infectious Disease, St George's Hospital, London, UK
15ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
16Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
17United Kingdom Department of Health and Social Care, London, UK
18National Heart and Lung Institute, Imperial College London, London, UK
19National Infection Service, Public Health England, [A: Where?]
20Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
21Roslin Institute, University of Edinburgh, Edinburgh, UK

Tóm tắt

Abstract Objective To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). Participants 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. Main outcome measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 10 9 /L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. Conclusions Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). Study registration ISRCTN66726260.

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