• Heloisa Helena de Sousa Marques, Maria Fernanda Badue Pereira, Angélica Carreira Dos Santos, Thais Toledo Fink, Camila Sanson Yoshino de Paula, Nadia Litvinov, Claudio Schvartsman, Artur Figueiredo Delgado, Maria Augusta Bento Cicaroni Gibelli, CarvalhoWerther Brunow deWB0000-0002-9164-616XHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Vicente Odone Filho, Uenis Tannuri, Magda Carneiro-Sampaio, Sandra Grisi, DuarteAlberto José da SilvaAJDS0000-0002-8707-4904Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Leila Antonangelo, Rossana Pucineli Vieira Francisco, Thelma Suely Okay, Linamara Rizzo Batisttella, CarvalhoCarlos Roberto Ribeiro deCRR0000-0002-1618-8509Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Alexandra Valéria Maria Brentani, Clovis Artur Silva, HC-FMUSP Pediatric COVID Study Group, Adriana Pasmanik Eisencraft, Alfio Rossi Junior, Alice Lima Fante, Aline Pivetta Cora, Amelia Gorete A de Costa Reis, Ana Paula Scoleze Ferrer, Anarella Penha Meirelles de Andrade, Andreia Watanabe, Angelina Maria Freire Gonçalves, Aurora Rosaria Pagliara Waetge, Camila Altenfelder Silva, Carina Ceneviva, Carolina Dos Santos Lazari, Deipara Monteiro Abellan, Emilly Henrique Dos Santos, Ester Cerdeira Sabino, Fabíola Roberta Marim Bianchini, Flávio Ferraz de Paes Alcantara, Gabriel Frizzo Ramos, Gabriela Nunes Leal, Isadora Souza Rodriguez, PinhoJoão Renato RebelloJRRHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR., Jorge David Avaizoglou Carneiro, Jose Albino Paz, Juliana Carvalho Ferreira, Juliana Ferreira Ferranti, Juliana de Oliveira Achili Ferreira, Juliana Valéria de Souza Framil, Katia Regina da Silva, Kelly Aparecida Kanunfre, Karina Lucio de Medeiros Bastos, Karine Vusberg Galleti, Lilian Maria Cristofani, Lisa Suzuki, CamposLucia Maria ArrudaLMAHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR., Maria Beatriz de Moliterno Perondi, Maria de Fatima Rodrigues Diniz, Maria Fernanda Mota Fonseca, Mariana Nutti de Almeida Cordon, Mariana Pissolato, Marina Silva Peres, Marlene Pereira Garanito, Marta Imamura, Mayra de Barros Dorna, Michele Luglio, Mussya Cisotto Rocha, Nadia Emi Aikawa, Natalia Viu Degaspare, Neusa Keico Sakita, Nicole Lee Udsen, Paula Gobi Scudeller, Paula Vieira de Vincenzi Gaiolla, Rafael da Silva Giannasi Severini, Regina Maria Rodrigues, Ricardo Katsuya Toma, Ricardo Iunis Citrangulo de Paula, Patricia Palmeira, Silvana Forsait, FarhatSylvia Costa LimaSCLHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR., Tânia Miyuki Shimoda Sakano, Vera Hermina Kalika Koch, and Vilson Cobello Junior.
• Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
• Clinics (Sao Paulo). 2021 Jan 1; 76: e3488.

ObjectivesTo compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19).MethodsThis was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results.ResultsThe frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035).ConclusionsHalf of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

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