Italian data confirm mild pediatric COVID-19 disease course


Data from China had indicated a milder disease course overall in pediatric cases and now new data from Italy continues to confirm that conclusion.

Information from China had indicated that pediatric cases of COVID-19 made up a small part of the overall caseload and nearly all were mild. Now new data from Italy, the second hot spot for COVID-19 during the pandemic, continues this trend.1

The Italian research used the Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) study that included 100 children aged younger than 18 years and infected with COVID-19, which had been confirmed by reverse-transcriptase–polymerase-chain-reaction testing of nasal or nasopharyngeal swabs. The participants were assessed between March 3, 2020, and March 27, 2020 in 17 pediatric emergency departments.

In the cohort, the median age was 3.3 years and exposure to the disease from either an unknown source or a source outside the family was linked to 55% of the cases. Twelve percent of the children looked ill and 54% had a temperature of at least 37.6°C. The common symptoms were cough, which was seen in 44% of the children, and no feed or difficulty feeding, seen in 23% of children. Difficulty eating was more common in children aged younger than 21 months. The earliest known symptoms of COVID-19- fever, cough, and shortness of breath-were seen in 28 of the 54 febrile patients.

Oxygen saturation values below 95% were seen in 4% of the children and all these patients had imaging evidence of lung involvement. Among the 9 patients who required respiratory support, 6 had a coexisting condition.

The researchers concluded that the incidence of transmission through familial exposure was lower than previous cohorts, which could have been caused by the late lockdown of the country. They also found that fewer patients in the Italian cohort had moderate-to-severe disease, which may have been a result of the predominant use of chest radiography instead of chest computed tomography that could have identified subclinical pneumonia.


1.    Parri N, Lenge M, Buonsenso D. Children with COVID-19 in pediatric emergency departments in Italy. N Engl J Med. May 1, 2020. Epub ahead of print. doi: 10.1056/NEJMc2007617

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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