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Clinics (Sao Paulo, Brazil)
2021;76 e3488.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital.

Heloisa Helena de Sousa Marques, Maria Fernanda Badue Pereira, Angélica Carreira Dos Santos, Thais Toledo Fink, Camila Sanson Yoshino de Paula, Nadia Litvinov, Claudio Schvartsman, Artur Figueiredo Delgado, Maria Augusta Bento Cicaroni Gibelli, Werther Brunow de Carvalho, Vicente Odone Filho, Uenis Tannuri, Magda Carneiro-Sampaio, Sandra Grisi, Alberto José da Silva Duarte, Leila Antonangelo, Rossana Pucineli Vieira Francisco, Thelma Suely Okay, Linamara Rizzo Batisttella, Carlos Roberto Ribeiro de Carvalho, Alexandra Valéria Maria Brentani, Clovis Artur Silva, HC-FMUSP Pediatric COVID Study Group, Adriana Pasmanik Eisencraft, Alfio Rossi Junior, Alice Lima Fante, Aline Pivetta Cora, Amelia Gorete A de Costa Reis, Ana Paula Scoleze Ferrer, Anarella Penha Meirelles de Andrade, Andreia Watanabe, Angelina Maria Freire Gonçalves, Aurora Rosaria Pagliara Waetge, Camila Altenfelder Silva, Carina Ceneviva, Carolina Dos Santos Lazari, Deipara Monteiro Abellan, Emilly Henrique Dos Santos, Ester Cerdeira Sabino, Fabíola Roberta Marim Bianchini, Flávio Ferraz de Paes Alcantara, Gabriel Frizzo Ramos, Gabriela Nunes Leal, Isadora Souza Rodriguez, João Renato Rebello Pinho, Jorge David Avaizoglou Carneiro, Jose Albino Paz, Juliana Carvalho Ferreira, Juliana Ferreira Ferranti, Juliana de Oliveira Achili Ferreira, Juliana Valéria de Souza Framil, Katia Regina da Silva, Kelly Aparecida Kanunfre, Karina Lucio de Medeiros Bastos, Karine Vusberg Galleti, Lilian Maria Cristofani, Lisa Suzuki, Lucia Maria Arruda Campos, Maria Beatriz de Moliterno Perondi, Maria de Fatima Rodrigues Diniz, Maria Fernanda Mota Fonseca, Mariana Nutti de Almeida Cordon, Mariana Pissolato, Marina Silva Peres, Marlene Pereira Garanito, Marta Imamura, Mayra de Barros Dorna, Michele Luglio, Mussya Cisotto Rocha, Nadia Emi Aikawa, Natalia Viu Degaspare, Neusa Keico Sakita, Nicole Lee Udsen, Paula Gobi Scudeller, Paula Vieira de Vincenzi Gaiolla, Rafael da Silva Giannasi Severini, Regina Maria Rodrigues, Ricardo Katsuya Toma, Ricardo Iunis Citrangulo de Paula, Patricia Palmeira, Silvana Forsait, Sylvia Costa Lima Farhat, Tânia Miyuki Shimoda Sakano, Vera Hermina Kalika Koch, Vilson Cobello Junior
Author Information
  1. Heloisa Helena de Sousa Marques: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  2. Maria Fernanda Badue Pereira: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  3. Angélica Carreira Dos Santos: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  4. Thais Toledo Fink: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  5. Camila Sanson Yoshino de Paula: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  6. Nadia Litvinov: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  7. Claudio Schvartsman: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  8. Artur Figueiredo Delgado: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  9. Maria Augusta Bento Cicaroni Gibelli: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  10. Werther Brunow de Carvalho: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  11. Vicente Odone Filho: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  12. Uenis Tannuri: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  13. Magda Carneiro-Sampaio: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  14. Sandra Grisi: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  15. Alberto José da Silva Duarte: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  16. Leila Antonangelo: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  17. Rossana Pucineli Vieira Francisco: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  18. Thelma Suely Okay: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  19. Linamara Rizzo Batisttella: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  20. Carlos Roberto Ribeiro de Carvalho: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  21. Alexandra Valéria Maria Brentani: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  22. Clovis Artur Silva: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. ORCID
  23. Adriana Pasmanik Eisencraft: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  24. Alfio Rossi Junior: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  25. Alice Lima Fante: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  26. Aline Pivetta Cora: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  27. Amelia Gorete A de Costa Reis: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  28. Ana Paula Scoleze Ferrer: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  29. Anarella Penha Meirelles de Andrade: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  30. Andreia Watanabe: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  31. Angelina Maria Freire Gonçalves: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  32. Aurora Rosaria Pagliara Waetge: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  33. Camila Altenfelder Silva: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  34. Carina Ceneviva: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  35. Carolina Dos Santos Lazari: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  36. Deipara Monteiro Abellan: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  37. Emilly Henrique Dos Santos: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  38. Ester Cerdeira Sabino: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  39. Fabíola Roberta Marim Bianchini: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  40. Flávio Ferraz de Paes Alcantara: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  41. Gabriel Frizzo Ramos: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  42. Gabriela Nunes Leal: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  43. Isadora Souza Rodriguez: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  44. João Renato Rebello Pinho: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  45. Jorge David Avaizoglou Carneiro: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  46. Jose Albino Paz: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  47. Juliana Carvalho Ferreira: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  48. Juliana Ferreira Ferranti: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  49. Juliana de Oliveira Achili Ferreira: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  50. Juliana Valéria de Souza Framil: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  51. Katia Regina da Silva: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  52. Kelly Aparecida Kanunfre: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  53. Karina Lucio de Medeiros Bastos: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  54. Karine Vusberg Galleti: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  55. Lilian Maria Cristofani: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  56. Lisa Suzuki: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  57. Lucia Maria Arruda Campos: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  58. Maria Beatriz de Moliterno Perondi: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  59. Maria de Fatima Rodrigues Diniz: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  60. Maria Fernanda Mota Fonseca: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  61. Mariana Nutti de Almeida Cordon: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  62. Mariana Pissolato: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  63. Marina Silva Peres: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  64. Marlene Pereira Garanito: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  65. Marta Imamura: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  66. Mayra de Barros Dorna: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  67. Michele Luglio: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  68. Mussya Cisotto Rocha: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  69. Nadia Emi Aikawa: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  70. Natalia Viu Degaspare: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  71. Neusa Keico Sakita: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  72. Nicole Lee Udsen: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  73. Paula Gobi Scudeller: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  74. Paula Vieira de Vincenzi Gaiolla: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  75. Rafael da Silva Giannasi Severini: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  76. Regina Maria Rodrigues: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  77. Ricardo Katsuya Toma: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  78. Ricardo Iunis Citrangulo de Paula: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  79. Patricia Palmeira: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  80. Silvana Forsait: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  81. Sylvia Costa Lima Farhat: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  82. Tânia Miyuki Shimoda Sakano: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  83. Vera Hermina Kalika Koch: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
  84. Vilson Cobello Junior: Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
PMID: 34852143 DOI: 10.6061/clinics/2021/e3488

Abstract

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.

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MeSH Term

Adolescent
COVID-19
Child
Cohort Studies
Cross-Sectional Studies
Humans
Infant, Newborn
SARS-CoV-2
Systemic Inflammatory Response Syndrome
Tertiary Care Centers
Journal Article
Article has an altmetric score of 1

Word Cloud

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