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COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

2020; Elsevier BV; Volume: 4; Issue: 9 Linguagem: Inglês

10.1016/s2352-4642(20)30177-2

2352-4650

Florian Götzinger, Begoña Santiago, Antoni Noguera‐Julián, Miguel Lanaspa, Laura Lancella, Francesca Ippolita Calò Carducci, Natalia Gabrovska, Svetlana Velizarova, Petra Prunk, Veronika Osterman, Uroš Krivec, Andrea Lo Vecchio, Delane Shingadia, Antoni Soriano‐Arandes, Susana Melendo, Marcello Lanari, Luca Pierantoni, Noémie Wagner, Arnaud G. L’Huillier, Ulrich Heininger, Nicole Ritz, Srini Bandi, Nina Krajcar, Srđan Roglić, Mar Santos, Christelle Christiaens, Marine Creuven, Danilo Buonsenso, Steven B. Welch, Matthias Bogyi, Folke Brinkmann, Marc Tebruegge, Jasmin Pfefferle, Angela Zacharasiewicz, Angelika Berger, Roland Berger, Volker Strenger, Daniela S. Kohlfürst, Anna Zschocke, Benoît Bernar, Burkhard Simma, Edda Haberlandt, Christina Thir, Ariane Biebl, Koen Vanden Driessche, Tine Boiy, Daan Van Brusselen, An Bael, Sara Debulpaep, Petra Schelstraete, Ivan Pavić, Ulrikka Nygaard, Jonathan Peter Glenthoej, Lise Jensen, Ilona Lind, Mihhail Tistsenko, Ülle Uustalu, Laura Buchtala, Stephanie Thee, Robin Kobbe, Cornelius Rau, Nicolaus Schwerk, Michael Barker, Μαρία Τσολιά, Irini Eleftheriou, Patrick J. Gavin, O Kozdoba, Borbála Zsigmond, Piero Valentini, Inga Ivaškevičienė, Rimvydas Ivaškevičius, Valentina Vilc, Elisabeth H. Schölvinck, A Rojahn, Anastasios Smyrnaios, Claus Klingenberg, Í.T. De Carvalho, Andreia Ribeiro, Анна Старшинова, Ivan Solovič, Lola Falcón-Neyra, Olaf Neth, Laura Minguell, Matilde Bustillo Alonso, Aida M. Gutiérrez-Sánchez, Borja Guarch Ibáñez, Francesc Ripoll, Beatriz Soto, Karsten Kötz, Petra Zimmermann, Hanna Schmid, Franziska Zucol, A. Niederer, Michael Buettcher, Benhur Şirvan Çetin, Olga Bilogortseva, Vera Chechenyeva, Alicia Demirjian, Fiona Shackley, Lynne McFetridge, Lynne Speirs, Conor Doherty, Laura Jones, Paddy McMaster, Clare Murray, Frances Child, Yvonne Beuvink, Nick Makwana, Elizabeth Whittaker, Amanda Williams, Katy Fidler, Jolanta Bernatoniene, Rinn Song, Zoe Oliver, Andrew Riordan,

SARS-CoV-2 and COVID-19 Research

BackgroundTo date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic.MethodsThis multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission.Findings582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support.InterpretationCOVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.Fundingptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.