Children with SARS-CoV-2 infection during the novel coronaviral disease (COVID-19) outbreak in Iran: an alarming concern for severity and mortality of the disease

Background The rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections led to public health crises globally and the number of pediatric patients with Coronavirus Disease 2019 (COVID-19) is still rising.

The aim of this study was to describe the epidemiological, clinical, laboratory, and imaging features of hospitalized patients with COVID-19 at an Iranian referral pediatrics hospital and to compare these parameters between hospitalized patients with and without severe disease, multisystem inflammatory syndrome in children (MIS-C) and children with acute COVID-19, as well as deceased and discharged cases.

Methods This study included hospitalized children and adolescents (≤ 18 years) with suspected COVID-19 who had positive results for SARS-CoV-2.

Results Among the 262 patients with suspected COVID-19, 142 confirmed COVID-19 cases were included in the study.

A total of 11 children were diagnosed as MIS-C.

The majority of the cases with MIS-C were male, (n = 9, 82%) which is significantly higher than children (n = 61, 47%) with acute COVID-19 ( P  = 0.03).

Fifty patients (35%) were shown to have a more severe form of COVID-19.

Ninety percent of the cases (n = 45) with severe COVID-19 had comorbidities that was significantly higher than cases with non-severe or mild disease (n = 41, 45%; P  < 0.0001).

A mortality rate of 10% was reported (n = 14).

Ninety-three percent of the deceased cases (n = 13) had comorbidities that were significantly higher than discharged patients (n = 73, 57%; P  = 0.009).

Conclusion The increasing number of children with severe COVID-19 is cause for great concern.

Underlying diseases, mainly cardiovascular diseases, cancer, and malignancies, are associated with greater risk of development of severe COVID-19 and even death in children.

On the other hand, pediatric patients with MIS-C usually develop a milder form of the disease.

However, evaluation specific immunological responses in children to explore the delayed inflammatory syndrome are highly recommended.