Characteristics of Hospitalized Children Positive for SARS-CoV-2: Experience of a Large Center

Abstract

OBJECTIVES Define the spectrum of disease in pediatric inpatients with a positive SARS-CoV-2 test result in a manner relevant to pediatric hospital medicine. METHODS Retrospective case series of all patients aged <22 years hospitalized at our institution with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test result between May 1, 2020, and September 30, 2020. Demographic, clinical, and outcome data were collected and analyzed. RESULTS Three distinct presentations were associated with acute SARS-CoV-2 positivity. Patients had incidental infection (40%), were potentially symptomatic (47%), or were significantly symptomatic (14%). The average length of stay differed between the significantly symptomatic group and the incidental and potentially symptomatic groups (P =.002). Average age differed among these groups, with significantly symptomatic patients older by >2 years. Fifty-five percent of incidental and 47% of potentially symptomatic patients had at least 1 identified comorbidity, whereas 90% of significantly symptomatic patients had at least 1 (P = .01). There was a significant relationship between obesity (P = .001) and asthma (P = .004) and severe disease. Additionally, there was a statistically significant difference between groups with respect to fever, hypoxia, supplemental oxygen use, duration of supplemental oxygen, and ICU admission, with a significantly higher percentage of patients in the significantly symptomatic group meeting each of these criteria (P < .001 for all categories). CONCLUSIONS Pediatric patients hospitalized with SARS-CoV-2 fall into distinct categories, which are critical to understanding the true pathology of SARS-Cov-2 as it relates to hospitalized pediatric patients. Most hospitalized patients who test positive for SARS-CoV-2 are asymptomatic or have a reason for hospitalization other than coronavirus disease 2019.