ABSTRACT
Background: In 2020, Brazil became the epicentre of the coronavirus disease (COVID-19) pandemic in Latin America, resulting in an unparalleled health catastrophe. Nevertheless, comprehensive clinical reports in Brazilian children are not available. Methods: This retrospective, hospital-based, active surveillance study was performed to identify paediatric patients with COVID-19 who presented at a private academic medical centre in a large urban area between March 2020 and March 2021. Clinical and demographic information was analysed for those requiring hospitalization, those with severe illness and those with clinical syndromes. Results: In total, 964 symptomatic cases were evaluated; of these, 17.7% required hospitalization, and 27.5% of hospitalized cases were classified as severe/critical. Acute bronchiolitis and pneumonia were the most common causes of hospitalization among the severe cases. Twenty-seven hospitalized children fulfilled the diagnostic criteria for multi-system inflammatory syndrome (median age 29 months; 85.2% cases were non-severe). A significant co-existing condition was present in 29% of hospitalized children. The risk of hospitalization was higher in children with at least one comorbidity, children aged <2 years and obese children. Increased risk of severe disease was described among those with leukopenia, leukocytosis or any significant comorbidity. No deaths occurred among the study population. Conclusion: Although most children with COVID-19 experienced mild disease, and no deaths occurred among the study population, a significant proportion of cases required hospitalization and developed severe illness. Obesity, young age, underlying comorbidity, leukopenia and leukocytosis were risk factors for hospitalization or severe disease.
ABSTRACT
Introduction: The first case of coronavirus disease 2019 (COVID-19) in Brazil was diagnosed in February 2020. On March 20, the Ministry of Health issued Ordinance no. 467, regulating the use of telemedicine during the pandemic period. One of the various modalities of telemedicine is telemonitoring. Objective: To report our experience with telemonitoring and evaluate its applicability in the follow-up of the first 100 children who received the diagnosis of COVID-19 after visiting the emergency department of Sabará Hospital Infantil ("Hospital Sabará") and who had no indications for hospitalization. Methods: The care records of the children were retrospectively analyzed, and telephone contact with the families of patients who did not complete the proposed telemonitoring protocol was initiated. Results: The average age of the children was 5.5 years, and a slight male predominance (54/100) was observed. Comorbidities were present in 24/100. The source of infection was family members living in the same household in 88/100 and other sources in 12/100. In the first telemonitoring, 44% of the evaluated patients were asymptomatic. In the second telemonitoring, 81% of the patients were asymptomatic. Telemonitoring was completed by 70% of the children. A total of 14 children returned to the emergency department, 11 of whom spontaneously (2/11 were admitted) and 3 under the indication of telemedicine (3/3 were admitted). Conclusions: Telemonitoring proved to be a clinically valuable resource in the follow-up of children with COVID-19, as it allowed continuity of care and identified patients with indications to return to the emergency department of Hospital Sabará and for hospitalization, thus avoiding unnecessary emergency department visits.
ABSTRACT
ABSTRACT Objective: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. Methods: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. Results: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. Conclusions: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently. RESUMO Objetivo: Descrever as manifestações clínicas e a gravidade de crianças e adolescentes acometidos pela COVID-19 atendidos no Sabará Hospital Infantil. Métodos: Trata-se de estudo transversal, retrospectivo e observacional. Foram analisados os atendimentos (pronto-socorro, enfermaria e Unidade de Terapia Intensiva - UTI) que apresentavam diagnóstico de COVID-19 confirmado por RT-qPCR. A gravidade dos casos foi classificada de acordo com o Consenso Chinês. Resultados: Entre as 115 crianças incluídas, houve predominância do sexo masculino (57%) e a mediana de idade foi de 2 anos. Vinte e duas crianças foram hospitalizadas, sendo 12 em UTI. Do total, 26% apresentava comorbidades com predomínio de asma (13%). Febre, tosse e coriza foram os sintomas mais frequentes. Sintomas respiratórios foram relatados por 58% das crianças e gastrintestinais por 34%. Três crianças apresentavam-se assintomáticas, 81 (70%) com sintomas de vias aéreas superiores, 15 (13%) com quadro de pneumonia leve e 16 (14%) com pneumonia grave. As crianças hospitalizadas eram mais jovens do que as não hospitalizadas (7 meses vs. 36 meses). Nas hospitalizadas, observamos maior frequência de irritabilidade, dispneia, sonolência, desconforto respiratório, baixa saturação de oxigênio e hepatomegalia. Radiografia de tórax foi realizada por 69 crianças com 45% de exames alterados. Nenhuma criança necessitou de ventilação mecânica e não houve óbitos. Conclusões: Observamos que crianças e adolescentes acometidos pela Covid-19 apresentaram, em sua maioria, quadros leves e limitados a sintomas de via aérea superior. A gravidade do quadro clínico da Covid-19 foi maior entre as crianças de menor idade que tinham com maior frequência sintomas gastrintestinais e pulmonares.
ABSTRACT
ABSTRACT Objective: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. Methods: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. Results: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. Conclusions: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently. RESUMO Objetivo: Descrever as manifestações clínicas e a gravidade de crianças e adolescentes acometidos pela COVID-19 atendidos no Sabará Hospital Infantil. Métodos: Trata-se de estudo transversal, retrospectivo e observacional. Foram analisados os atendimentos (pronto-socorro, enfermaria e Unidade de Terapia Intensiva - UTI) que apresentavam diagnóstico de COVID-19 confirmado por RT-qPCR. A gravidade dos casos foi classificada de acordo com o Consenso Chinês. Resultados: Entre as 115 crianças incluídas, houve predominância do sexo masculino (57%) e a mediana de idade foi de 2 anos. Vinte e duas crianças foram hospitalizadas, sendo 12 em UTI. Do total, 26% apresentava comorbidades com predomínio de asma (13%). Febre, tosse e coriza foram os sintomas mais frequentes. Sintomas respiratórios foram relatados por 58% das crianças e gastrintestinais por 34%. Três crianças apresentavam-se assintomáticas, 81 (70%) com sintomas de vias aéreas superiores, 15 (13%) com quadro de pneumonia leve e 16 (14%) com pneumonia grave. As crianças hospitalizadas eram mais jovens do que as não hospitalizadas (7 meses vs. 36 meses). Nas hospitalizadas, observamos maior frequência de irritabilidade, dispneia, sonolência, desconforto respiratório, baixa saturação de oxigênio e hepatomegalia. Radiografia de tórax foi realizada por 69 crianças com 45% de exames alterados. Nenhuma criança necessitou de ventilação mecânica e não houve óbitos. Conclusões: Observamos que crianças e adolescentes acometidos pela Covid-19 apresentaram, em sua maioria, quadros leves e limitados a sintomas de via aérea superior. A gravidade do quadro clínico da Covid-19 foi maior entre as crianças de menor idade que tinham com maior frequência sintomas gastrintestinais e pulmonares.