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<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children/adolescents diagnosed or hospitalized with COVID-19. Secondly, to describe health outcomes amongst children/adolescents diagnosed with previous seasonal influenza.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>International network cohort.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Diagnosed and/or hospitalized children/adolescents with COVID-19 at age &lt;18 between January and June 2020; diagnosed with influenza in 2017-2018.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome (ARDS), multi-system inflammatory syndrome (MIS-C), and death.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 55,270 children/adolescents diagnosed and 3,693 hospitalized with COVID-19 and 1,952,693 diagnosed with influenza were studied.</jats:p><jats:p>Comorbidities including neurodevelopmental disorders, heart disease, and cancer were all more common among those hospitalized vs diagnosed with COVID-19. The most common COVID-19 symptom was fever. Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more common in COVID-19 than influenza.</jats:p><jats:p>In-hospital treatments for COVID-19 included repurposed medications (&lt;10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%).</jats:p><jats:p>Hospitalization was observed in 0.3% to 1.3% of the COVID-19 diagnosed cohort, with undetectable (N&lt;5 per database) 30-day fatality. Thirty-day outcomes including pneumonia, ARDS, and MIS-C were more frequent in COVID-19 than influenza.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Despite negligible fatality, complications including pneumonia, ARDS and MIS-C were more frequent in children/adolescents with COVID-19 than with influenza. Dyspnea, anosmia and gastrointestinal symptoms could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19.</jats:p></jats:sec><jats:sec><jats:title>What is already known on this topic?</jats:title><jats:list list-type="bullet"><jats:list-item><jats:p>Most of the early COVID-19 studies were targeted at adult patients, and data concerning children and adolescents are limited.</jats:p></jats:list-item><jats:list-item><jats:p>Clinical manifestations of COVID-19 are generally milder in the pediatric population compared with adults.</jats:p></jats:list-item><jats:list-item><jats:p>Hospitalization for COVID-19 affects mostly infants, toddlers, and children with pre-existing comorbidities.</jats:p></jats:list-item></jats:list></jats:sec><jats:sec><jats:title>What this study adds</jats:title><jats:list list-type="simple"><jats:list-item><jats:label>⍰</jats:label><jats:p>This study comprehensively characterizes a large international cohort of pediatric COVID-19 patients, and almost 2 million with previous seasonal influenza across 5 countries.</jats:p></jats:list-item><jats:list-item><jats:label>⍰</jats:label><jats:p>Although uncommon, pneumonia, acute respiratory distress syndrome (ARDS) and multi-system inflammatory syndrome (MIS-C) were more frequent in children and adolescents diagnosed with COVID-19 than in those with seasonal influenza.</jats:p></jats:list-item><jats:list-item><jats:label>⍰</jats:label><jats:p>Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more frequent in COVID-19, and could help to differentiate pediatric COVID-19 from influenza.</jats:p></jats:list-item><jats:list-item><jats:label>⍰</jats:label><jats:p>A plethora of medications were used during the management of COVID-19 in children and adolescents, with great heterogeneity in the use of antiviral therapies as well as of adjunctive therapies.</jats:p></jats:list-item></jats:list></jats:sec>

Original publication

DOI

10.1101/2020.10.29.20222083

Type

Working paper

Publisher

Cold Spring Harbor Laboratory

Publication Date

30/10/2020