Results
The mean age of the patients was 108.64±65.61 months (1.5 months-18 years). Of the patients, 51.4% (54/105) were male. There were 13 patients in Group 1, 46 patients in Group 2, and 46 patients in Group 3. The most common cause of transmission in pediatric patients was contacting with a family member diagnosed with COVID-19 (n=91, 86.7%).
Four of our patients (3.8%) had an accompanying disease at the time of diagnosis. A 16-year-old patient had more than one comorbid factor (Diabetes Mellitus + Beta thalassemia major + chronic respiratory disease). A 5.5-month-old patient was followed-up for Primary Hemophagocytic lymphohistiocytosis before the diagnosis. One of whom with Down syndrome and Acute lymphoblastic leukemia, and the other with the diagnosis of epilepsy and was on anti-epileptic drugs.
The most common admission complaints were dry cough (n=17, 16.2%), fever (n=16, 15.2%), lassitude and fatigue (n=14, 13.3%) and headache (n=12, 11.4%), respectively. The admission complaints of the patients were summarized in Table 1.
Chest CT was performed on 48 patients. Pulmonary ground-glass opacities (n=11, 10.4%) were the most common chest CT findings detected in these patients (Fig. 1, 2 ). Other common findings were local patchy shadow (n=5, 4.7%) and bilateral patchy shadow (n=4, 3.8%), respectively. Pleural effusion was also seen in one of our patients.
A significant number of patients were clinically asymptomatic (n=59, 56.2%). Three patients required intensive care. The classification based on clinical severity was summarized in Table 1. The mean length of hospital stay was 4 (range 1-19) days in the patients who required hospitalization. No mortality was observed in any of our patients.
Antibiotics and antiviral agents were used to treat the patients. The most commonly used drugs were the combinations of azithromycin (n=72, 68.6%), hydroxychloroquine (n=21, 20%), antibiotics (n=10, 9.5%), oseltamivir (n=8, 7.6%), lopinavir-ritonavir (n=4, 3.8%). Only 3 of our patients required the use of oxygen. High flow oxygen was administered to a patient who required intensive care.
The clinical and laboratory findings of the patients were summarized in Table 2.
According to the differences between Groups 1, 2, and 3, the contact history was significantly lower in Group 1 than in other two groups (p<0.001). The frequency of male gender was significantly higher in Group 2 (p=0.032) than in other two groups. Besides, sore throat and cough complaints were significantly higher in Group 3 than in other two groups (p=0.004, p=0.008) (Table 3).
The distribution of the clinical severity of the patients by age groups was shown in Table 4.
The Wbc and D-dimer levels, lymphocyte, and platelet counts were significantly higher in the patients in Group 2 compared to other two groups (p=0.007, p<0.001, p0.001, p=0.005). The creatinine levels were lower in the patients in Group 1 than in other two groups (p<0.001), and the blood urea levels were lower in the patients in Group 1 than in the patients in Group 3 (p=0.048). The parameters that showed significant differences among the groups regarding the evaluation of the laboratory findings were shown in Table 5.
There were significant positive correlations between length of hospitalization and CRP, ferritin, fibrinogen, Body temperature (r=0.871, r=0.400, r=0.648, r=0.585, p<0.001, p=0.021, p<0.001, p<0.001, respectively) and negative correlations with oxygen saturation, (r=-0.765, p<0.001). We modelled a multiple linear regression analysis with enter model to define the independent variables of duration of length of hospital stay. Gender, CRP, ferritin levels, fibrinogen, oxygen saturation were included into the analysis. CRP was only independently factor associated longer duration of hospitalization (p<0.001, table 6).