Children more resilient against coronavirus, study reveals

SAN ANTONIO – The majority of children with COVID-19 in 26 countries fared well clinically compared to adults during the first four months of the pandemic, a newly released study shows.

Researchers from the Long School of Medicine at The University of Texas Health Science Center at San Antonio prepared the study, which is the largest systematic review to date of children and young adults with COVID-19. EClinicalMedicine, a journal of The Lancet, on June 26 published the results, which cover studies published between Jan. 24 and May 14.

Among the findings:

• 19% of the pediatric population with COVID-19 had no symptoms.
• 21% exhibited patchy lesions on lung X-rays.
• 5.6% suffered from co-infections, such as flu, on top of COVID-19.
• 3.3% were admitted to intensive care units.
• Seven deaths were reported.

“Our data is compiled from 131 studies and encompasses 7,780 patients who span the pediatric age spectrum,” said study senior author Alvaro Moreira, MD, MSc, assistant professor of pediatrics at UT Health San Antonio and a fellowship-trained neonatologist.

“In the study we report the most common symptoms, quantify laboratory findings and describe imaging characteristics of children with COVID-19,” Dr. Moreira said. “Furthermore, we summarize treatments that were administered and offer an initial glimpse of a handful of patients who met the U.S. Centers for Disease Control and Prevention (CDC) criteria for multisystem inflammatory syndrome in children.”

Symptoms

The most frequent symptoms, similar to the adult population, were fever and cough. Those were found in 59% and 56% of the pediatric population.

In 233 individuals, a past medical history was noted, and among this group, 152 were children with compromised immune systems or who had underlying respiratory or cardiac disease.

The number of children with excellent outcomes surprised the research team. “Although we are hearing about severe forms of the disease in children, this is occurring in very rare circumstances,” Dr. Moreira said.

The majority of journal articles were from China. The largest study that was included was a case series of 2,572 patients reported by the U.S. CDC COVID-19 team.

Laboratory measures that were consistently abnormal in pediatric COVID-19 patients included inflammatory markers such as creatine kinase, interleukin-6 and procalcitonin.

Few severe cases

Thankfully, only a small number of patients met inclusion for multisystem inflammatory syndrome in children. Their disease paralleled the extreme forms of COVID-19 seen in adults.

“Children with systemic inflammation had a significant decrease in the amount of lymphocytes in their blood,” Dr. Moreira said. “COVID-positive children who didn’t have the extreme form of the disease had 42% lymphocytes in their blood, versus 11% in children with the multisystem syndrome.”

Lymphocytes are one of the main types of immune cells in the body.

Kidney failure was seen in nine pediatric patients, liver failure also in nine and shock in 19. Mechanical ventilation was required by 42 patients.

The study does not take into consideration a new surge of patients in New York, England and Italy where specialists are now starting to see children with multisystem inflammatory syndrome, Dr. Moreira said.

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In addition to Dr. Moreira, the team consists of two study co-first authors who are medical students in the Long School of Medicine; a pediatric intensive care fellow at Texas Children’s Hospital in Houston; undergraduate students from Texas A&M, The University of Texas at San Antonio and Cottey College; a student accepted into the McGovern Medical School at UTHealth in Houston; and a San Antonio high school student.

COVID-19 in 7,780 pediatric patients A systematic review

Ansel Hoang, Kevin Chorath, Axel Moreira, Mary Evans, Finn Burmeister-Morton, Fiona Burmeister, Rija Naqvi, Matthew Petershack, Alvaro Moreira, MD, MSc

First published: June 26, 2020, EClinicalMedicine

https://doi.org/10.1016/j.eclinm.2020.100433

The Long School of Medicine at The University of Texas Health Science Center at San Antonio is named for Texas philanthropists Joe R. and Teresa Lozano Long. The school is the largest educator of physicians in South Texas, many of whom remain in San Antonio and the region to practice medicine. The school teaches more than 900 students and trains 800 residents each year. As a beacon of multicultural sensitivity, the school annually exceeds the national medical school average of Hispanic students enrolled. The school’s clinical practice is the largest multidisciplinary medical group in South Texas with 850 physicians in more than 100 specialties. The school has a highly productive research enterprise where world leaders in Alzheimer’s disease, diabetes, cancer, aging, heart disease, kidney disease and many other fields are translating molecular discoveries into new therapies. The Long School of Medicine is home to a National Cancer Institute-designated cancer center known for prolific clinical trials and drug development programs, as well as a world-renowned center for aging and related diseases.

The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio, is one of the country’s leading health sciences universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated more than 37,000 alumni who are leading change, advancing their fields, and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways “We make lives better®,” visit http://www.uthscsa.edu.

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