Clinical characteristics of a case series of children with c
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In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection spread rapidly among humans worldwide.1 The epidemiological, radiological, and clinical characteristics of COVID‐10 have been reported in the general population.2 Elderly patients with comorbidities may be more likely infected by SARS‐CoV‐2 according to previous reports.3 In addition, the characteristics of COVID‐19 in special populations were also reported. Nine confirmed infants in Wuhan under 1 year of age with a good prognosis was reported. However, to the best of our knowledge, few studies have reported the clinical characteristics of COVID‐19 in children outside of Wuhan. We describe the epidemiological and clinical characteristics of COVID‐19 in a case series of 10 children aged from 1 year to 18 years in Jiangsu province, China

The most common initial symptoms at the onset of illness were fever (4 [40.0%]), followed by cough (3 [30.0%]) and headache (2 [20.0%]). Other symptoms, including fatigue, sore throat, muscle ache, shortness of breath, or diarrhea were not presented in these patients. Three of 10 (30%) patients had no clinical symptoms before admission, who received COVID‐19 screening due to the contact with confirmed COVID‐19 family members.

No patient showed leucopenia and lymphopenia on admission. Three of 10 patients (30%) had mildly increased levels of alanine aminotransferase (ALT). The peak level of ALT was 69 U/L. Inflammatory markers including C‐reactive protein and procalcitonin were normal in all patients. All patients received a chest CT examination on admission. Typical findings of chest CT images were observed in five (50.0%) patients. Of the five patients, two (40.0%) had bilateral and one (20.0%) had unilateral ground‐glass opacity.
Oxygen therapy was required in one (10.0%) patients. Five (50.0%) patients received antiviral treatment, including lopinavir/ritonavir (n = 4; 40.0%), interferon α‐2b (n = 4; 40.0%), and oseltamivir . One (10.0%) patient was given antibiotic treatment and no patient was treated with corticosteroid or gamma globulin. As of February 25, 2020, 5 (50.0%) of 10 patients have been discharged, and 5 (50.0%) patients remained hospitalized. No patient had severe complications and no patient developed a severe illness in our study. No patient was admitted to the ICU or deceased in our study.

The current study reported the clinical characters of 10 children with confirmed COVID‐19 from Jiangsu province, China. Most of the patients had contact with confirmed COVID‐19 family members in our study, suggesting that family clustering infection is common in infected children and the protection for children who had a confirmed family member is important.

Consistent with adult patients, fever and cough were the most common symptoms at the onset of illness. However, asymptomatic infection is common in children patients. The illness in all children was mild and no severe complication occurred. Previous studies in adult patients reported intensive care unit (ICU) admission ranged from 26.1% to 32% and the fatality rate ranged from 4.3% to 15%.3 Our results suggested that the outcomes of children were better than adult patients. Similarly, Wei et al4 reported nine infants and no patient was admitted to the ICU or had any severe complications. The children rarely combine comorbidities and may be less susceptible to developing severe illness than elderly patients.4
Although the antiviral effect was uncertain, 50.0% of patients received antiviral therapy in this study. However, the benefit of antiviral therapy for COVID‐19 remains unclear. In addition, 10.0% of patients received empirical antibacterial therapy, and no patient received corticosteroids or gamma globulin due to the mild illness.

In conclusion, compared with adult patients, COVID‐19 children present less severe symptoms and have better outcomes. Our results provide valuable information to understanding the epidemiological and clinical features of COVID‐19 in children.