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Limited paediatric data on COVID-19 suggest that it is less frequent and severe in children than in adults.1 2 Spain is currently one of the most affected countries. Our aim was to describe the patients under the age of 18 years diagnosed with SARS-CoV-2 infection at Hospital La Paz (Madrid) in the first month of the outbreak (11 March to 9 April 2020). Inclusion criteria were all children who underwent PCR for SARS-CoV-2 in nasopharyngeal smears.
Out of 349 children, 58 (16.6%) had a positive PCR for SARS-CoV-2 (table 1). All had compatible symptoms, except two cases in which the PCR was indicated prior to intensive care unit (ICU) admission or surgery. Twenty-five (43%) children were followed up as outpatients. Nine of them (35%) attended a second time but none required hospital admission. Thirty-three (57%) children were admitted, after a median of 3 days of symptoms (IQR 2–5). Among inpatients, 14 (42.4%) received oxygen therapy for a median of 3 days (IQR 2–6.75), and 12 (36.4%) were given antibiotics (ceftriaxone 11/12). Three patients with severe disease received remdesivir, and tocilizumab was added in two with an inflammatory syndrome. Five children were admitted to the PICU (15% of those hospitalised), three for severe COVID-19, one for hypertensive crisis and the other for diabetic ketoacidosis. A 5-month-old infant with dilated cardiomyopathy and Hurler’s disease died. Median hospital stay was 3 days (IQR 2–5).
This is the largest series of children with COVID-19 in Spain to date. Most children had good outcomes, including five outpatients with pneumonia. On the other hand, the rates of hospital (57%) and ICU (15%) admission were high. These data must be interpreted carefully. In China, where hospitalisation of only 2%–3% of infected children has been described,2 numerous asymptomatic or mildly symptomatic children, in the context of infections at home, were tested.3 In Spain, during the study period diagnostic tests were only conducted in those children with compatible respiratory symptoms and criteria for hospitalisation or underlying chronic pathology.4 Children with mild symptoms were not tested even if there was a confirmed case in the household. About 40% of children in our series had underlying medical conditions. These patients consulted promptly after symptom onset, and according to national recommendations, underwent viral testing even with mild symptoms. In our series, their outcome was similar to healthy children. Although the role of hydroxychloroquine in the treatment of COVID-19 remains to be clarified, we used it in a high percentage of patients following local recommendations,5 without side effects.
Our study has several limitations, including its retrospective design. It is the experience of a single tertiary centre, and screening was carried out only in cases that required hospitalisation or had chronic diseases. Despite this, we consider it to be a reliable description of COVID-19 in children in Spain.
Contributors MdC-V, IM-E, TdR and FB-A conceptualised and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. MB-B, MP-G, JARD, RLL, MAMG, PB-G, IG-B, PGS, JMS, BdM-L, TS and AM-E collected data, collaborated in drafting the initial manuscript, and reviewed and revised the manuscript. CC co-ordinated and supervised data collection, collaborated in drafting the initial manuscript and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.