Year : 2021 Month : October Volume : 10 Issue : 43 Page : 3726-3729,

Clinical Spectrum of COVID-19 in Children at a Tertiary Care Centre

Ankur Joshi1, Gunjan Kela2, Nandini Sodha3, Pragya Mehta4

1, 2, 3, 4 Department of Paediatrics, Sri Aurobindo Medical College and Post Graduate Institute,
Indore, Madhya Pradesh, India.

CORRESPONDING AUTHOR

Dr. Gunjan Kela, Department of Paediatrics, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Email : drgunjankela@yahoo.com

INTRODUCTION

Increasing cases of COVID-19 have been reported in children globally. Admission frequency, though, is significantly lower than adults in COVID-19. Recent evidence suggests that children likely have the same or higher viral loads. Our study is retrospective, with the purpose to describe the clinical spectrum of this disease in children and response of treatments, along with its effect in the neonatal period. As very few cases have been encountered with severe disease, and are illustrated in this study, attempting to understand the course of severe illness.

Globally and, as compared with adults, fewer cases of COVID-19 have been reported in children (age 0 - 17 years).1,2 Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have a less severe illness from COVID - 19 compared to adults.3,4 Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults,5,6 and those children can spread the virus effectively in households and camp settings.7,8

       At our institute, 10 % of the total COVID-19 cases were from the paediatric population. Among the early neonatal period following delivery to a COVID positive mother, most of them were FT deliveries (83 %), with the majority delivered vaginally. In relation to PT cases, all were delivered vaginally including 4 cases of documented intrauterine device (IUD) by induction of labour with a zero trans-placental transmission rate. Out of positive cases in the perinatal period, all were presented as necrotizing enterocolitis (NEC). In the paediatric age group of 1 month – 17 years, varied symptoms were present. Children having comorbidities contributed to poor prognosis.

PRESENTATION OF CASE

We have admitted over 600 cases of COVID-19 in the paediatric age group, including neonatal cases. Out of which, a few severe cases with varied presentation are illustrated below, requiring intensive care.

 

Paediatric Age Group 1 month – 17 years

1. A 15 yr old female came with a complaint of haemoptysis and chest pain, HRCT chest gave ground-glass attenuation suggestive of alveolitis (2 - 4 %). COVID-19 RT - PCR came positive, and the child responded well to HCQS, steroids and symptomatic treatment. There was no history of contact with COVID-19.

 

 

2. A 13 year old female was admitted with fever and signs of congestive cardiac failure. 2D-echo revealed myocarditis, child improved well on steroids and intravenous immunoglobulin (IVIG). RT - PCR for COVID-19 was positive. The history of contact was negative.

 

3. A 13 year old female child was admitted with bicytopenia (anaemia and thrombocytopenia) and positive for malarial antigen and peripheral smear was reported with P. vivax.



4. For persistent fever, the child was evaluated for COVID- 19 as she had a contact history with COVID-19. Chest X-ray revealed bilateral homogeneous opacities and bilateral pleural effusion. COVID-19 RT - PCR came positive. Due to the financial constraints of parents, treatment could not be continued at the institute. After discharge, the child lost to follow up.

 

5. 11 year old female, with a history of an operated case of acyanotic CHD (VSD) at 7 years of age, came with acute abdomen, dyspnoea and multiple organ dysfunction syndrome (MODS). The stay of the child was only 9 - 10 hours at our institute. CT chest and abdomen suggested ground-glass attenuation with fibrotic changes in both lungs, along with moderate pleural effusion and ascites (CORAD 5). The patient outcome was fatal because of, multi-organ dysfunction and acute respiratory distress syndrome (ARDS).

 

6. A 7 year old female child came with meningitis and acute cervical lymphadenitis. CT chest revealed 40 - 45 % lung involvement as ground-glass opacities, suggestive of COVID-19 infection with CORAD score 5 (CT score 12 / 25). USG neck local region findings suggestive of tubercular aetiology, diagnosis confirmed with FNAC. In this case, the child had a tubercular infection-causing immunocompromised state and hence developed COVID -19 as a co-infection. The child recovered from COVID- 19 uneventfully.

 

 

7. A 5-month-old undernourished male child was admitted with acute respiratory illness and breathing difficulty without any history of contact. 40 % lung involvement presented on CT chest as ground-glass appearance probably due to COVID-19(CORAD - 5; CT score 7 / 25). RT - PCR came positive later. The child showed improvement on remdesivir.