Haematological Manifestations of SARS-COV-2 Infection in Symptomatic Children with COVID-19

Introduction: The incidence of COVID-19 is remarkably less in thepaediatric population as compared to the adult population, withchildren accounting for 1-5% of diagnosed cases. Data in childrenregarding the spectrum of haematological manifestations and thecorrelation with prognosis is limited. Aims &Objectives: To describe the haematological manifestationsand peripheral smear findings of SAR-CoV-2 infection in COVID-19positive symptomatic children and to study the association betweendifferent haematological parameters with patient age, disease severity, and patient outcomes.Materials &Methods: A retrospective cum prospective review of thehaematological parameters and peripheral smear findings of thechildren diagnosed with COVID-19 positive status over four monthswas conducted in the Department of Pathology, Maulana AzadMedical College from September 2020 to December 2020. Allsymptomatic paediatric patients less than 18 years of age, with laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndromecoronavirus-2) infection were included. Complete blood count andperipheral smear findings were reviewed and a comparison of theproportion of children with abnormal hematological parametersacross various age groups and different disease severity (mild, moderate, and severe) was done. The data obtained were analyzed usingMS Excel and Statistical Package for the Social Sciences (SPSS)software, version 26. Prior approval of the institutional ethical committee was taken.Result: Seventy-two SARS-CoV-2 proven infection (RT-PCR positive) cases were included ranging in age from 2 days to 18 years.Anaemia was the most common haematological abnormality (62.5%)followed by leucopoenia (21%). Lymphopenia and neutropenia wereseen in 18% of cases respectively. Leucocytosis was seen in 10% ofcases with raised neutrophil to leucocyte ratio (NLR) seen in 30.Conclusions: Children have milder disease outcomes and a lesserdegree of haematological changes than adults. This can be attributedto a better immune response in otherwise healthy children. Howeverlarger studies are required for further understanding of paediatricpopulation outcomes.

Pediatric coronavirus disease 2019: clinical features and management

There is a lack of clarity regarding management of COVID-19 infection in children. This review aims to summarize the key clinical presentations and management of Pediatric COVID-19. The Medline database was searched for seminal articles and guidelines on COVID-19 presentation and management in children less than 18 years of age. COVID-19 has a lower incidence (1-5% of reported cases worldwide), causes milder disease with lower need for intensive care admission and lower mortality rate (0-0.7%) in children compared with adults. Multisystem inflammatory syndrome is a rare but severe complication in children. Majority of patients require supportive care including adequate hydration, nutrition and antipyretics. Supplemental oxygen therapy should be given in moderate to severe cases with all precautions to prevent air-borne COVID-19 spread. Steroids may be helpful in severe cases. Anticoagulation is indicated in moderate to severe cases with risk factors. More data on the efficacy and safety of antivirals and immunomodulators in children is needed.