The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID-19: A 6-months prospective study

Objectives To perform a comprehensive clinic, laboratory, and instrumental evaluation of children affected by coronavirus disease (COVID-19). Methods Children with a positive result of nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) underwent laboratory tests, anal and conjunctival swab, electrocardiography, lung, abdomen, and cardiac ultrasound. Twenty-four-hour ambulatory blood pressure monitoring was performed if abnormal basal blood pressure. Patients were followed-up for 6 months. Results Three hundred and sixteen children were evaluated; 15 were finally included. Confirmed family member SARS-CoV-2 infection was present in all. Twenty-seven percent were asymptomatic. Anal and conjunctival swabs tests resulted negative in all. Patients with lower body mass index (BMI) presented significantly higher viral loads. Main laboratory abnormalities were: lactate dehydrogenase increasing (73%), low vitamin D levels (87%), hematuria (33%), proteinuria (26%), renal hyperfiltration (33%), and hypofiltration (13%). Two of the patients with hyperfiltration exhibited high blood pressure levels at diagnosis, and persistence of prehypertension at 6-month follow-up. No abnormalities were seen at ultrasound, excepting for one patient who exhibited B-lines at lung sonography. Immunoglobulin G seroconversion was observed in all at 1-month. Conclusions Our study confirm that intra-family transmission is important. The significant higher viral loads recorded among patients with lower BMI, together with low vitamin D levels, support the impact of nutritional status on immune system. Renal involvement is frequent even among children with mild COVID-19, therefore prompt evaluation and identification of patients with reduced renal function reserve would allow a better stratification and management of patients. Seroconversion occurs also in asymptomatic children, with no differences in antibodies titer according to age, sex and clinical manifestations.

Automated summary

This study conducted a comprehensive evaluation of children affected by COVID-19, finding the importance of intra-family transmission and the impact of nutritional status on the immune system. Even children with mild cases of the disease may have renal involvement, highlighting the need for prompt evaluation and identification of patients with reduced renal function reserve.