Clinical Profile and Outcome of Neonates and Children Diagnosed with COVID-19 in Tertiary Level Teaching hospital in Eastern Nepal

Objetives

The disease spread all over the world so rapidly that WHO has declared global health emergency and pandemic on 30 January 2020.Neonates and children are affected less frequently as compared to adults.Impact and outcome of COVID on neonates are unknown and a major public health concern.However, evidence on neonatal covid is still limited.

INTRODUCTION
Corona virus disease 2019 (COVID- 19) is an acute respiratory infection caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).The disease is originated from Wuhan, China in January 2020 and spread all over the world so rapidly that the world health organization (WHO) has declared global health emergency and pandemic on 30 January 2020. 1,2Peoples of almost all countries of the world are affected by COVID-19.Neonates and children are affected less frequently as compared to adults.They are mostly asymptomatic (40-71.9%)or experience clinically mild disease. 3,4,5Although severe disease in children does occur, mortality is around 0.2-2.3%. 3,5 ll age groups of children are affected equally without gender difference.Children with COVID-19 present with symptoms of fever, persistent cough, shortness of breath, body ache, headache, sore throat, abdominal pain, vomiting, diarrhea, anorexia and loss or change to sense

METHODOLOGY
This was observational, descriptive study done in the pediatric intensive care unit (PICU), NICU and COVID ward, Birat Medical College Teaching Hospital (BMCTH) from July2021 to June2022.All the children admitted in Pediatric ICU, NICU and covid ward with positive RT-PCR and antibody were included who gave written and verbal consent.Samples for RT-PCR were taken from the nasal and posterior wall of pharynx while COVID antibody was detected from blood samples.Pulse oximetry, arterial blood gas analysis (ABG), complete blood count (CBC), coagulation profile, renal function test (RFT), liver function test (LFT), C-reactive protein (CRP), serum ferritin, chest radiograph and other investigations were done for the management of the disease.Data were collected by using specifically designed performa after taking written and oral consent.Ethical clearance was done from the Institutional Review Committee, BMCTH.Data entry was done in Microsoft offices excel worksheet and analyzed by using IBM SPSS version 26.Frequency, median, mode, interquartile range were used for descriptive study.

Corona virus disease 2019 (COVID-19
) is an acute respiratory infection caused by SARS-CoV-2.The disease spreaded all over the world so rapidly that WHO has declared global health emergency and pandemic on 30 January 2020. 2 As the disease emerges as pandemic, more evidence about the clinical profile and outcome are required.Impact and outcome of COVID on neonates are unknown and a major public health concern.However, evidence on neonatal covid is still limited.
According to previous study, all age groups of children are affected equally without gender difference. 17However, in our study most common admitted children were age of 10-14 year (20, 31.7%)followed by 1-5 years (14, 2.2%) and male children (35; 56%) were commonly admitted as compared to female (28; 44%).Sayeeda Anwar et al from Bangladesh reported that maximum patients (30.6%) were of 11-15year old and most of them were male. 18Similarly, Nagaraj MV et al also reported majority of children were male (52.5%). 19itially it was thought that the disease is acute respiratory illness and affects the respiratory system mainly but it affects other systems also.In our study, the most commonly involved systems were respiratory (42, 66.7%) followed by gastrointestinal (28, 44.5%) and neuromuscular (13, 20.6%).Karthi Nallasamy et al observed that respiratory symptoms were predominant followed by gastrointestinal symptoms. 20 In our study, the rate of PICU admission was higher than the literature but this is due to institute policy.Initially all patients of covid were admitted in PICU and NICU.The rate of PICU admission was 2.8-8% in the recent study. 17st commonly presenting complaint was fever (48, 76.2%) followed by cough (34, 54%) and shortness of breath (24, 38.1%).The other complains were noisy breathing (5, 7.9%), throat pain (4, 6.3%), seizure (5, 7.9%), sore throat, conjunctivitis, weakness, myalgia, body ache.nasal discharge.Albulabi W et al from Saudi Arabia also reported that fever was the most observed symptom (69%), followed by cough (34.3%). 17In retrospective study by Preeti Singh et al from northern India, the most common presentation was fever followed by cough and fast breathing. 21bservational studies across the world have reported similar frequency of symptom.A systematic review of 27 studies showed, fever to be present in half (41%-58%) followed by cough (39%-51%) and rapid breathing (6%-17%). 22 our study most commonly admitted children were of moderate (34, 54%) in disease severity followed by severe (18, 29%) and mild disease (11, 17%) based on the WHO COVID-19 clinical management Living guidance 25 January 2021 disease severity categories. 14In the recent literatures, the severe disease ranges from 7% to 65%. 19,23,24 Lth of hospital stay (LOS) of covid-19 was average 4.85 days (median; 4 days) while in newborn length of stay was average 7.33 days(median; 4days).A systematic review and data synthesis of 52 studies by Rees et al reported that the median length of hospital stay(LOS) ranged from 4 to 53 days within China, and 4 to 21 days outside of China. 25 this study, 60 (95.2%) children survived and three (4.8%)diedout of 63 children.Lara S Shekerdemian et al reported that the overall case fatality rate in the cross-sectional study was 4.2% up to the time of the report. 26

LIMITATIONS OF STUDY
This is a single centre study in private set up and there was low sample size.

Table 3 :
Demography of children with MIS-C

Table 4 :
Outcome of Children and neonates with COVID-19 21eeti Singh et al from north India also reported that the mortality rate of patients with SARS-CoV-2 was 11.4% (29/255).21

Table 3
30,32nue... similar to multicenter study by Oncel MY et al and systemic review by Smith V, Seo D, Warty R, Payne O, Salih M, Chin KL, et a with NICU admission rate of 86.4% and 76.92% respectively.30,32Eight(88.9%)newbornssurvivedwhileone (11.1%)pretermdieddue to multi-organ failure.Death of the newborn would be due to COVID or complication of prematurity.A systemic review with nine studies and 92 cases showed there was neonatal death (1.2%).30CONCLUSIONSCOVID-19presentation in children ranged from mild to severe disease.Respiratory was most common involved system.Fever, cough and difficulty in breathing were common features in children while fever, difficulty in breathing and sepsis in neonates.Thirteen percent children developed MIS-C.Mortality was noted low that is 4.8% in children and 11.1% in neonates RECOMMENDATIONS 1) For prevention of neonatal transmission of COVID 19, precaution should be taken during delivery and neonatal care.2) Immunization of the children with COVID vaccine to prevent morbidity and mortality of children.