Coronavirus causes a wide variety of symptoms in children, and targeted testing of kids may miss cases, a study published in an American Academy of Pediatrics journal finds.
Dr. Rabia Agha and colleagues from Maimonides Children’s General Hospital in Brooklyn studied 22 children with coronavirus who were admitted to the hospital over four weeks between March and April, when local transmission was widespread.
They found that most of the patients did not have classic coronavirus symptoms, in contrast to what is seen in adults and some pediatric reports from China.
The patients had a wide variety of symptoms and circumstances. Almost half of the 22 patients were less than a year old. Fifteen patients had a fever. Nine had respiratory symptoms. Two had seizures. Sixteen had no known contact with a Covid-19 patient, and two were entirely asymptomatic. None of the patients in the study died.
The researchers initially followed guidelines from the US Centers for Disease Control and Prevention, only testing patients with fever, cough and shortness of breath, those who had traveled to high risk countries and those who had close contact with a confirmed coronavirus case. As the rate of infections increased, they started testing all admitted patients, regardless of their symptoms.
Of the four patients who required mechanical ventilation, only one did not have an underlying health condition – an otherwise healthy child who suffered a cardiac arrest. Three of the patients on ventilators qualified for compassionate use of the antiviral drug remdesivir and were eventually taken off the ventilators.
Seven patients who were hospitalized for non-Covid symptoms, including bacterial infections, appendicitis and inflamed muscles, tested positive for the virus. The researchers say it is unclear how large a role coronavirus played in their illness.
The youngest patient in the study, who was 11 days old with a healthy mother, was likely infected by asymptomatic family members at home.
The Maimonides team said infection rates at a particular time and region, rather than confirmed contact alone, should drive testing strategies, noting that 41% of the patients they studied would have been overlooked because they did not meet the then-recommended coronavirus testing criteria.
“Guidelines to test pediatric patients need to be broadened and take into account that patients presenting with other illnesses may also be positive for COVID-19,” they wrote.
“Testing of all hospitalized patients will not only identify cases early in the course of their admission process, but will also help prevent inadvertent exposure of other patients and health care workers, assist in cohorting infected patients and aid in conservation of personal protective equipment.”