Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. eu Li Herui Families COVID-19: Their with with Children Comparison 21 A of Treatments and Findings Clinical Huang hlrnadterfmle ihCVD1,i re opoievlal xeine n iesm insights. some of give and processes experiences clinical valuable to compared provide Methods due to and and order limited summarized in Materials still we and COVID-19, was Herein, old, with COVID-19 features years families information. epidemical with their 10 and incomplete patients and clinical than children and pediatric the younger reported size of were clinicians sample understanding cases Although small studies, 1% old. retrospective years than 19 some less to in which 10 from among ranged mainland, cases 1.23% China in in patients (SARS-CoV-2) 72,314 2 coronavirus clustering syndrome family respiratory of acute reported 26 patients severe few to to of up susceptible consequence confirmed worldwide less cases thought reported 5,404,512 were than been children more had China, deaths Wuhan, in 343,514 outbroke and (COVID-19) 2019 disease coronavirus Since investigated. further be to need and Introduction neutropenia therapy recovered patients, antiviral mild been of in Efficiency presented atypical had COVID-19 were children. patients abnormalities with of Laboratory patients All characteristic Pediatric potential adults. a than Conclusions: ribavirin. lesions be days). lung received may 17 limited two (median and used days symptoms arbidol; children milder 4-47 therapy: given as 16 admission antiviral were received of (10.5%). duration adults 7 ribavirin with All and lopinavir/ritonavir; discharged 36.8%). (18.4%) took (9.5%, chloroquine children 12 shadow (71.1%), of patchy (57.1%, arbidol interferon; half opacity and (76.3%), ground-glass nearly (15.8%) 7.9%) interferon of leucocytes, (14.3%, chill consisted (92.1%), involvement, 26.3%) stripes lopinavir/ritonavir (6.8%), pulmonary (19.0%, 23.7%), had fatigue decreased adult (14.3%, adults or (44.7%), 38 32 spots 68.4%) and the 60.5%), expectoration children (76.2%, 18 Among 15 (63.2%), normal from neutrophils. had (14.3%). cough were decreased cases expectoration 90.5% showed (63.2%), Most asymptomatic years, and fever 5 17 (15.8%). (19.0%) Besides included to dizziness cough adults. 1 symptoms and five (66.7%), the from than fever in major aged shorter as disease the onset, females) performed illness coronavirus 11 patients, after mainly novel and days patients males 2 laboratory-conformed pediatric hospitals (10 with designated children cases, to families 21 admitted of 38 and total clusters their family In and Retrospective Results: children Methods: hospitals. 21 COVID-19. designated with among patients pediatric executed of was characteristics clinical analysis of understanding the deepen To Objective: Abstract 2020 27, May 6 5 4 3 2 1 intnCnrlHospital Central Xiangtan Hospital People’s Second Yueyang Hospital Guilin Central of Zhuzhou hospital people’s second The Changsha of Hospital First Hospital Xiangya Second 4 eln Liu Wenlong , 1 iigMa Yiming , 3 ag aesre yteCieeCne o ies oto n Prevention and Control Disease for Center Chinese the by series case large A . 5 1 iga Jiang Mingyan , iagZeng Zihang , 2 hn eiti ainsgaulyicesdwt h eprcognition deeper the with increased gradually patients pediatric Then, . 1 uhiZeng Huihui , 6 igChen Ping , 1 th 1 1 a 2020 May hgoZhou Zhiguo , n a Chen Yan and , 1 ttebgnigo h epidemic, the of beginning the At . 2 iiLiu Qimi , 1 3 Peng , 4 included Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. rmilesostt diso agdfo o7dy mda as Q - as ncide,which children, in days) demographic 1-3 the summarized IQR 1 days; Table 2 days). (median 2-7 Duration days IQR comparison. 7 18 days; a data. 4 to from made clinical (median and 1 were 38 and adults collected their from patients were close than Thus, age, ranged 90.5% shorter and of patients). admission significantly years of 2-7 were cases) 84 to total from to onset (three exposure 18 (ranged A illness from members of tourism to female), confirmed from cases). history 1 17 Hubei 3.47 and specific (four from of male or Wuhan a average ranged (21 Wuhan an had from families patients had (47.6%) The cases), returned which patients had (three girls. clusters, 10 who family Wuhan 11 years). and people in 3-13.5 boys with residence IQR 10 contact including years; with 8 included, Hubei, were (median to old age all years of at 18 years pneumonia coronavirus under 17 novel cases laboratory-proven 21 with patients ages. 444 identified analysis retrospective Our Information Fisher’s Clinical and or Demographic chi-square arguments, continuous for Result tests Mann-Whitney’s parameters. categorical or adults for and t for tests children IQR) student exact between range, (interquartile Comparisons using median variables. analyzed as (SPSS presented categorical software were were for 18.0 Data (percentage) SPSS count processing. with of data variables, independently, the continuous date researchers for three USA) first by IL, Chicago, verified the Inc., and from entered was calculated information was All clearance virus swab nasopharyngeal of Analysis for length Statistical results The negative negative. consecutive that two apart. to least RT-PCR hours at positive 24 having as collected defined specimens was effusion virus of Pleural lesions, Clearance of shadow. morphology patchy CT the the and underwent to or stripes patients Definitions according symptomatic spots, All findings signs. became (GGO), accompanying image opacity initially SARS-CoV-2. as summarized ground-glass patients assessed for We as were the test COVID-19. described when RT-PCR of were day of course which the result the as positive in defined a scan was had intervention. onset cases without illness asymptomatic records of medical Zhuzhou the date symptoms from Changsha, The images, clinical collected scan of (CT) were epidemics, tomography outcomes computed Center Demographics, chest clinical Treatment tests, and Hubei. laboratory Health City, treatment comorbidities, and exposure, Shiyan Public Hunan of Yueyang, in history the signs, District, District and Junshan Yunyang by of of Hospital provided Hospital Designated were People’s Hospital, Central patients Xiangtan all Hospital, Central of data The acquisition design. Data consent retrospective informed the City, Shiyan of in Hospital, District because Yunyang the Central waived of Changsha, Xiangtan Hospital clinical was of People’s Hospital, Hospital and analyzed Central First Hospital Zhuzhou University, and People’s the Second South of Yueyang collected Central committee of ethics we institutional Hospital Then, Xiangya the patients by Second approved all was cases. edition), protocol severe study (6th March The and COVID-19 to for mild by 23rd protocol into COVID-19 January them. control classified confirmed of 21st and and information prevention inpatients from assessed Chinese 444 hospitals the further designated of to transcription- were five series reverse accordance in real-time In a by assay detected from (RT-PCR) 23. specimens reaction included swab chain were nasopharyngeal in polymerase families SARS-CoV-2 of 38 presence their the and children 21 Participants and design Study 2 Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. nttlo 4 aoaoycnre nainsa l gs eiti niiul cone o . percentage. 4.7 for accounted individuals pediatric ages, deepen all at to al inpatients aimed et confirmed Lee families, laboratory their 444 of with total insights. showed comparisons In study make made This and and infection, infectors care. coronavirus age health pediatric novel pediatric older of with of understanding with deficit minors knowledge associated of a series outcomes perpetuating a subjects, clinical rare poor of consequence with province, in Hubei illness of Wuhan systemic conditions in health and underlying reported respiratory first (SARS-CoV-2), causes 2 China, coronavirus syndrome respiratory adults. acute duration Severe in admission days and 16.5 clearance and virus 14.0 recovered of children, Discussion been length in had The days individuals 17.0 clearance. All and virus 15 ribavirin. in of were and confirmation that lopinavir/ritonavir after hospitalization, were than discharged during treatment dysfunction common and liver antiviral detected more the was child whom were one of complications, chloroquine ar- identified no and oral had subjects arbidol and Most lopinavir/ritonavir, interferon more inhaled of lopinavir/ritonavir, received use oral adults the children. using Differently, most; methyl- drip. intravenous therapy: the intravenous globulin. with antiviral ribavirin bidol treated immune received and was intravenous 2 involvement supports and arbidol; system respiratory oral inhalation nervous central took nasal budesonide with or 7 prednisolone, cases) combined lopinavir/ritonavir; (12 who oral inhalation patient took interferon The adults. 12 accepted 38 16 cases); therapy, and (4 antiviral children received spray 21 patients the pediatric in 19 outcomes Among and treatment the showed involvement 4 bilateral Table showed often adults no Outcomes and children, had were Treatment which the adults opacity, ground-glass with 15.8% were Compared and lesions infiltration. common children patchy most cases. with 28.6% The asymptomatic images. patients. in CT of observed in pneumonia characteristics of radiological evidence clear the adults. summarizes of 3 42.1% Table 23.7%, 76.3%, adults. in 63.2% and protein in children Findings C-reactive observed of decreased Radiological procalcitonin, 4.8% was or rate, 38.1%, creatinine normal sedimentation 47.6%, increased had in erythrocyte Abnormalities but observed increased cases families. rare, were indicators, pediatric their were inflammation than 95.2% biochemistry for common blood As more 2. which and Table neutropenia, in lymphocytes showed shown of children was 10 findings counts. laboratory leucocytes of summary A expectoration 63.2%), Examination (24, Clinical cough Laboratory 36.8%). 63.2%), convulsion. (14, (24, febrile fever fatigue as and identified adults: were 44.7%) in variety which (17, and signs, clinical frequent irritation 2-year-old had more most meningeal a were the children without in manifestations observed were 39.1 76.2% were 14.3%) of opisthotonos Among fever (3, and after pos- expectoration delirium people. girl vomiting, and by projectile screening 19.0%) detected Convulsion, (4, the and cough symptoms. in asymptomatic common 66.7%), SARS-CoV-2 were (14, fever for (23.8%) documented, five test manifestations RT-PCR pneumonia, of mild 23.5%), results as (4, itive presented the mellitus subjects were 11.8%) pediatric diabetes (2, All 64.7%), disease respiratory (11, and adults 17.6%) hypertension in (3, common. common comorbidities, diseases most more rheumatic with were 17.6%), 95.2% which adults (3, hospitalization, condition, diseases 17 during cardiovascular predisposing system Among or urinary disease infantile underlying (44.70%). of identified malformation no had congenital children diagnosed boy a Besides 6 nerdta hlrnhv ee udo ciiisaditrainltae,mkn hmls likely less them making travel, international and activities outdoor fewer have children that inferred 5 otne opors oadgoa admc hlrnwspi esattention less paid was Children pandemic. global toward progress to continues , 3 Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. nsmay aiircnatwstemi ot ftasiso usd fWhn eiti netr of infectors Pediatric Wuhan. of outside transmission of to route lead main may the was conditions, contact their familiar of of summary, size possibility In status the sample different introduce the with may First, 17, analysis Conclusion acknowledged. retrospective to be of 1 limitations to from natural biases. deserved aged the unrecognized study Third, cases current deficiencies. the the some Second, in small. limitations was several reducing are of efficiency in- There its China, to of owing Republic children patients. People’s were in pediatric drugs load the recommended above only viral of the was and Commission inhalation of symptoms Health aerosol all National and Although and sprays adult. terferon WHO in recovery) more by (100% used medicine prognosis were severityrecommended better chloroquine a the and COVID-19 had alleviate arbidol chloroquine, with to lopinavir/ritonavir, and patients contributed ribavirin also treatment arbidol, of respi- were lopinavir/ritonavir, antiviral prognosis interferon, and therapy Early the symptomatic immunoglobulin conditions. improve therapy, patients’ intravenous and antiviral the and on of glucocorticoid base consist therapy, considered infection Antibiotic COVID-19 supporting. of improvement ratory the modalities behind management lagged detection The lesions acid pulmonary nucleic indicated of and individuals, absorption manifestations adult the clinical or significantly, of symptomatic More the adult. in one commonly involved pat- and and children stripes illness in Spots, severe rarely infectors. found asymptomatic observed were and nega- were shadow symptomatic with chy also including opacity: infectors lesions ground-glass screening variable had of lung, adults bilateral tool or diagnostic unilateral important identification an early an was pathogen at tive scanning sensitive tomography more and computed was children Chest rate in sedimentation 4.8% infection. large erythrocyte 38.1%, coronavirus that need sedimentation 47.9%, novel indicated abnormality which of erythrocyte of adult, stage biomarkers: cases, rates in inflammatory mild the abnormalities 42.1% with 23.7%, three in laboratory protein, 76.3%, summarized indices c-reactive of We studies and laboratory review consensus. procalcitonin included of a rate, a the changes contrary, reach of atypical characteristics the as to but main reflected samples On presented children, as differences days). boy in lymphocytes foregoing (39 17-year-old decreased found The ( and shedding neutropenia—a was neutrophils 2.31 viral showed lymphopenia increased of of children reported No count duration in of leukocyte found longest (47.6%) limits. with was had half reference routine count Nearly leukocyte defined blood normal abnormal locally did. A the adults indices. to 13.2% laboratory relative in severity cases observed for most were factors derangements risk expectoration: consistent were and No comorbidities cough and by age followed older families, their Since and symptoms. adults. infection symptom children of in in source after frequent potential symptoms days became more common diagnosed, 1-7 most were members hospital the family was their to Fever after admitted test acid were nucleic by patients adults detected than pediatric shorter that significantly suggested onset, findings the COVID-19. clinical prevent from Our to data out the coronavirus figured than novel further children with exposure, be of infectors or should percentage Prevention contact pediatric higher of of and to history route Control led specific main Disease area, had for cases epidemic Center all to Chinese cohort, distance angiotensin- our closer by In with tract children. together respiratory humans in involved in characteristics receptor reported epidemical cell was of the coronavirus as (ACE2) Besides, 2 initially. enzyme converting virus the contract to 13 lua ffso,wihwstogtmr omna h tg ftedsaeprogressed disease the of stage the at common more thought was which effusion, Pleural . 18 11 oevr aeyadecec hudb osdrdcrflybfr sn in using before carefully considered be should efficiency and safety Moreover, . ailg fnvlpemnamsl rsne sgon-ls pct in opacity ground-glass as presented mostly pneumonia novel of Radiology . 3,5 a idmanifestations mild had , 15 4 tas ofimdta aiirtasiso a the was transmission familiar that confirmed also It . 4 . 3 16 × hrfr,teiprac fproa protection personal of importance the Therefore, . nti td,ptet eemil rae by treated mainly were patients study, this In . 10 7 hc a huh ob upre mechanisms purported be to thought was which , 9 L n etohl on f06 ( 0.63 of count neutrophils and /L) 12 norsuy 71 hlrnad60.5% and children 57.1% study, our In . 8 smtmtcidvdas hc were which individuals, Asymptomatic . 5 dlshdmore had adults , × 10 9 /L), 17 14 5 9 ; , . . Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. 2 uX uX in ,X ,Yn ,M ,L ,Wn ,ZagS a ,SegJ a ,QuY Li Y, Qiu H, Cai J, Sheng H, of Gao outside S, (SARS-Cov-2) Zhang coronavirus H, novel Wang 2019 S, the Li with C, infected Ma patients respiratory L, of COVID-19 Ying group K, with a Xu children in X, in findings Jiang tomography Clinical X, L. computed Wu Chest X, S. Xu Li 12. Y, Fang MED 2020. K, LAB RADIOL Li CHEM PEDIATR H, CLIN infection. Cui infection. W, COVID-2019 Li He with T, 11. Patients. patients Song Infected in Q, of abnormalities Guo J, Laboratory Specimens Xia P. Respiratory Y, 2020. M Upper Song L, M, in G Kang Load J, 10. Viral Yu Z, 2020;382(12):1177-1179. SARS-CoV-2 Hong MED J. H, J Wu Huang ENGL M, Infectious H, L, NEW Tian Peiris Liang the infection: A, M, H, of coronavirus Xia Huang Yen novel Y, publication F, J, Ge 2019 Ruan official X, L, with Wang an Zou P, children Liu of : 9. R, Series diseases Jia 2020. Case H, infectious America A Zhang of Clinical M. Y, human Society Zhang Zeng full-length Diseases features. Z, J, by Qu epidemiological Wang of SARS-CoV-2 L, J, and of Xu Journal Li recognition clinical Z, Yang C, the Wang D, for COVID-19? Lin H, basis to J, Chang Structural Xu Z. susceptible J, Q Cai less G, 8. Y children 2020;367(6485):1444-1448. X, N.Y.) Are L York, P. L, (New Y Wu Science Hsueh Z, H, ACE2. inpatients Y, Y Li Y, adult Y, Huang R of Wei P, mortality L, 7. Guan Chen for 2020. X, factors Y, Infection Gu risk 2020. and Hu B, and Lancet Immunology Song P, course The Microbiology, Y, Clinical Lee study. Wang cohort B. J, retrospective Cao Xiang 6. a H, Z, Chen Liu China: Wuhan, Y, Y, in Liu Zhang COVID-19 G, S, with Fan and Tu Control R, J, Disease Du Xu for T, X, Center Yu (COVID-19) Chinese F, 2019 the of Zhou From Disease Cases cluster 5. Coronavirus 314 familial the 72 From SK, A of Lessons 2020. Lo Report K. Important JAMA a H, Yuen and of Prevention. Tsoi CK, of Summary RW, China: Hui Characteristics Poon in M. H, CC, Outbreak of JM Chen Yip study W, VC, J, a Z Liu Cheng transmission: 4. 2020;395(10223):514-523. Jin F, person-to-person J, Lancet Z, Xing indicating Cai The Gao coronavirus J, J, cluster. JD, novel R, Yang family Xia 2019 Ip Jiang H, a T, the G, W, Chu Yu with Wang Chan KK, Z, associated J, To VK, Cheng pneumonia Xie K, The X, Poon L, Kok China. Gu K, Guo Wuhan, S, J, in H, Chan Yuan coronavirus Xu Gao JF, novel G, Y, 2019 Chan Fan Xiao with 3. L, infected M, Zhang patients Liu of Y, H, features Hu Li 2020;395(10223):497-506. Clinical J, W, Lancet B. Zhao Cao Yin L, J, X, Wang Ren Xie Q, X, W, Wu Li Y, Y, 127. Wei Wang report- C, situation (COVID-19): Huang Jiang 2019 2. M. disease five Coronavirus Dr. of Organization, workers Liu, systematic Health medical W. the World appreciate Dr. 1. undertook we Huang, and addition, P. In manuscript Dr. Chen. the Liu, Y. References: drafted Q. Dr. study. data, current and Dr. the the Ma Zhou, in Y. summarized Z. hospitals by Dr. Li Dr. designated collected with were H. Zeng, modifying patients H. Dr. and of Dr. Chen. review data P. Zeng, All study. Dr. Z. this Dr. and supervised Ma, and conduct Y. Chen Dr. Y. Dr. contribution: treatment, Author antiviral and lab of Further- abnormalities Acknowledgments investigate We changes. consensus. to the disease. blood on designed peripheral progressed reach different be and to indicated should severe aimed children, studies indicate of sample may half larger lesions nearly more, pleomorphic in Ground-glass families. lesion, neutropenia their atypical common than found most lesions pulmonary the limited was and opacity symptoms milder as presented SARS-CoV-2 5 Posted on Authorea 27 May 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159060412.24148774 — This a preprint and has not been peer reviewed. Data may be preliminary. findings-and-treatments-of-21-children-with-covid-19-a-comparison-with-their-families 4.docx Table file Hosted findings-and-treatments-of-21-children-with-covid-19-a-comparison-with-their-families 3.docx Table file Hosted findings-and-treatments-of-21-children-with-covid-19-a-comparison-with-their-families 2.docx Table file Hosted diagnosis, Updated S, W. findings-and-treatments-of-21-children-with-covid-19-a-comparison-with-their-families SN XF S, W, 1.docx YX YY L, G, Table LW LK S, L, XW JB the 2020. L, L, of ZS WJP JF version X, Y, file : ZD (condensed LP Hosted X, statement pediatrics C, BP YX consensus of Z, L, experts’ journal YJ M World J, children: X, RM edition). LJ in L, L, COVID-19 second XX WJ of J, D, prevention Y JK Z, and prognosis L, DC treatment G better W, L, TY a M Early J, and B, RM L. Y Y, cases Li YH milder H, S, shows KL Cao children J, 18. Yu in novel with L, COVID-19 2020. with PAEDIATR patients Cui of ACTA patients Y, pediatric review adults. Meng of Systematic than in C, prognosis JF. Liu features the Ludvigsson D, 2020. CT improve Wang 17. MED J, and and INTERN Liu severity Clinical J B, the Jiang (COVID-19). D. alleviate Z, disease Hu coronavirus Chen to Z, X, contributes Shi Li treatment W, antiviral X, Li 2020. J, Peng PULM Wu PEDIATR Y, patients 16. adults. 81 Guo from from 2020. J, points findings Diseases Radiological Different Infectious Shao with C. Lancet infection: patients Zheng W, COVID-19 The Y, pediatric Fan Xia study. severe J, descriptive of Gu a O, 15. features China: Alwalid Clinical Wuhan, Y, 2020. Z. in Cao PEDIATR Liu N, pneumonia J Jiang COVID-19 F, WORLD X, with Zhang study. Han observational J, H, center’s Ren Shi single H, 14. a Xiao Wuhan: X, in Lu 2019 H, disease Li coronavirus D, Sun 2020:m606. 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