COVID-19 Disease Severity Risk Factors for Pediatric Patients in Italy

• Published in: Pediatrics (Evanston) Vol. 146; no. 4
• Main Authors: Bellino, Stefania, Punzo, Ornella, Rota, Maria Cristina, Del Manso, Martina, Urdiales, Alberto Mateo, Andrianou, Xanthi, Fabiani, Massimo, Boros, Stefano, Vescio, Fenicia, Riccardo, Flavia, Bella, Antonino, Filia, Antonietta, Rezza, Giovanni, Villani, Alberto, Pezzotti, Patrizio
• Format: Journal Article
• Language: English
• Published: United States American Academy of Pediatrics 01.10.2020
• Subjects: Adolescent; Age; Age Factors; Betacoronavirus; Child; Child, Preschool; Children; Comorbidity; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - mortality; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Critical Care; Epidemiology; Female; Health care; Humans; Infant; Infant, Newborn; Italy - epidemiology; Logistic Models; Male; Pandemics; Patients; Pediatrics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - mortality; Pneumonia, Viral - therapy; Population Surveillance; Public health; Risk assessment; Risk Factors; SARS-CoV-2; Severity of Illness Index; Italy
• ISSN: 0031-4005; 1098-4275; 1098-4275
• DOI: 10.1542/peds.2020-009399

To describe the epidemiological and clinical characteristics of coronavirus disease (COVID-19) pediatric patients aged <18 years in Italy. Data from the national case-based surveillance system of confirmed COVID-19 infections until May 8, 2020, were analyzed. Demographic and clinical characteristics of subjects were summarized by age groups (0-1, 2-6, 7-12, 13-18 years), and risk factors for disease severity were evaluated by using a multilevel (clustered by region) multivariable logistic regression model. Furthermore, a comparison among children, adults, and elderly was performed. Pediatric patients (3836) accounted for 1.8% of total infections (216 305); the median age was 11 years, 51.4% were male, 13.3% were hospitalized, and 5.4% presented underlying medical conditions. The disease was mild in 32.4% of cases and severe in 4.3%, particularly in children ≤6 years old (10.8%); among 511 hospitalized patients, 3.5% were admitted in ICU, and 4 deaths occurred. Lower risk of disease severity was associated with increasing age and calendar time, whereas a higher risk was associated with preexisting underlying medical conditions (odds ratio = 2.80, 95% confidence interval = 1.74-4.48). Hospitalization rate, admission in ICU, disease severity, and days from symptoms onset to recovery significantly increased with age among children, adults and elderly. Data suggest that pediatric cases of COVID-19 are less severe than adults; however, age ≤1 year and the presence of underlying conditions represent severity risk factors. A better understanding of the infection in children may give important insights into disease pathogenesis, health care practices, and public health policies.