In this study, we reported on 23 pediatric patients with confirmed SAR-CoV-2 infection. Most patients had a definite family source of exposure. None of the patients experienced severe pneumonia, and their laboratory values showed few results beyond normal reference ranges. Studies have found that lower angiotensin-converting enzyme 2 levels and the immature function of the immune system in children may hamper production of a robust immune response, cytokine storm, and severe complications [7–9], which may underlie the differences in clinical manifestations, complications, and prognoses between children and adults [10–12]. Adverse prognostic factors in COVID-19 include older age (> 70 years), diabetes, uncontrolled hypertension, chronic obstructive pulmonary disease, and coronary artery disease, which are more common among adults than children [13].
The most common clinical features observed among children with COVID-19 included mild symptoms, such as dry cough, fever, sore throat, or diarrhea. Severe symptoms, such as dyspnea, acute renal failure, abnormal coagulation, sepsis, sepsis shock, and death, have been reported in children with COVID-19 [5, 14, 15], but the number of such severe cases is less than in adults [16–20]. These symptoms are also common in respiratory infections caused by other viruses, such as influenza, adenovirus, respiratory syncytial virus, parainfluenza, and rhinovirus [21, 22]. The results of laboratory tests conducted in adults with COVID-19 have shown elevated levels of serum ferritin, alanine aminotransferase, C-reactive protein, interleukin 6, and cardiac troponin [23]. Few studies have examined laboratory markers in children. Some studies have found that children with COVID-19 had leucocyte counts and lymphocyte levels and proportions that are within normal reference ranges [13,24−26] although there have been a few cases of children with lymphocytopenia, neutrophilia, or neutropenia [27, 28]. Zou et al. and others have found that lower platelet counts are associated with higher risk of severe COVID-19 [29, 30]. However, the children assessed in our study had laboratory markers that were generally within normal reference ranges.
Chest CT may aid in the clinical diagnosis of COVID-19 in children [31]. Commonly reported imaging findings among patients with COVID-19 include ground-glass opacity, consolidation, or interlobular septal thickening [21–34]. The lesions observed in our study were consistent with those that found ground-glass opacity and consolidation [25, 28, 32, 34]. CT imaging may differentiate among other virus infections for assisting in clinical diagnoses. Adenovirus tends to cause higher density, fewer subpleural, and more consolidation lesions. Influenza virus has been reported to have grid like changes. Respiratory syncytial virus may cause thickening of the bronchial wall. However, some patients with mild or moderate symptoms also have normal chest CT imaging results[34–37]; thus the value of radiologic approaches in the diagnosis of COVID-19 among pediatric patients will require further study and discussion.
At present, there are no specific inhibitors of SARS-CoV-2, and vaccines against the virus are under research and development. The National Health Commission of the People’s Republic of China published guidelines for the treatment of novel coronavirus pneumonia that include general treatment, oxygen support, antiviral treatment, circulatory support treatment, convalescent plasma therapy, and Chinese medicine treatment[38, 39]. For most patients with COVID-19 displaying mild symptoms, the therapeutic effects of symptomatic and supportive treatments, traditional Chinese medicine[40, 41], and antiviral treatments, are acceptable. However, an inflammatory cytokine storm is commonly observed in patients with severe symptoms who become critically ill with COVID-19. Thus, control of the inflammatory response at an early stage by treatment with cytokine antagonists, immunomodulators, or corticosteroids may avoid poor prognoses; however, the correct therapeutic timing, usage, dosage, and indications for corticosteroid use all need to be considered [42]. In addition, convalescent blood products and blood purification, such as through plasma exchange, adsorption, perfusion, or blood/plasma filtration[43], should also be considered. Some studies have also assessed the effects of angiotensin-converting enzyme 2 activators[44–46]. Further understanding of the pathogenesis of SARS-CoV-2 will contribute to more effective treatment of the disease.
In our study, all patients had mild symptoms and were in the early stage of the infection. Nasal continuous positive airway pressure was performed and antiviral therapies were provided, which mainly included lopinavir/ritonavir and arbidol hydrochloride, and traditional Chinese medicine was administered. Although the prognoses of these patients were good, they were not followed-up after hospital discharge. In addition, the number of cases was limited; thus, the value of these treatment strategies will need to be further studied.