Clinical Features of COVID-19 in Italian Outpatient Children and Adolescents During Parental, Delta, and Omicron Waves: a Prospective, Observational, Cohort Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2023 Aug 28

PMID 37635788

Authors

Costanza Di Chiara

Riccardo Boracchini

Giulia Sturniolo

Alessia Barbieri

Paola Costenaro

Sandra Cozzani

Marica De Pieri

Cecilia Liberati

Annachiara Zin

Andrea Padoan

Francesco Bonfante

Fatima Kakkar

Anna Cantarutti

Daniele Dona

Carlo Giaquinto

Affiliations

Soon will be listed here.

Abstract

Introduction: COVID-19 features changed with the Omicron variant of SARS-CoV-2 in adults. This study aims to describe COVID-19 symptoms in children and adolescents during the Parental, Delta, and Omicron eras.

Methods: A single-centre, prospective observational study was conducted on individuals aged 0-20 years attending the University Hospital of Padua (Italy) from April 2020 to December 2022. COVID-19 cases were defined by positive SARS-CoV-2 molecular detection and/or serology; patient/family symptoms and virological positivity were considered to determine the infection onset. Variables were summarized and compared using appropriate tests of descriptive statistics.

Results: A total of 509 cases [46% female, median age eight years (IQR: 4-12)] were studied. Three-hundred-eighty-seven (76%), 52 (10%), and 70 (14%) subjects experienced COVID-19 during the Parental, Delta, and Omicron waves, respectively. All subjects developed an asymptomatic/mild COVID-19. Overall, the most frequent symptoms were fever (47%) and rhinitis (21%), which showed a significant increasing incidence from the Parental to Omicron waves ( < 0.001). Conversely, diarrhea was most common during the pre-Omicron eras ( = 0.03). Stratifying symptoms according to the age group, fever, rhinitis, and skin rashes were observed more frequently among infants/toddlers; conversely, fatigue was more common in children older than five years. The duration of symptoms was similar across different SARS-CoV-2 variants of concern (VOCs); conversely, the number of symptoms varied according to the age group ( < 0.0001).

Discussion: This study showed differences in COVID-19 clinical presentation among infants, children, and adolescents and confirmed Omicron infection is more likely to be associated with upper respiratory symptoms. However, further population-based studies are needed to support these findings. In addition, active surveillance will play a crucial role in assessing the disease severity of future VOCs.

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