Clinical and Laboratory Features of PCR-Confirmed and Clinically Suspected COVID-19 Pediatric Patients: A Single Hospital-Based Experience During the First COVID-19 Wave in the United Arab Emirates

Nashwa M B Eldin; Maysa Saleh; Bahaaeldin Labib; Marwa Othman; Lalu Chacko; Daphne Mae; Lamiaa Elnour; Rami H Al-Rifai

doi:10.3389/fped.2022.830587

Clinical and Laboratory Features of PCR-Confirmed and Clinically Suspected COVID-19 Pediatric Patients: A Single Hospital-Based Experience During the First COVID-19 Wave in the United Arab Emirates

Front Pediatr. 2022 Mar 15:10:830587. doi: 10.3389/fped.2022.830587. eCollection 2022.

Authors

Nashwa M B Eldin¹, Maysa Saleh², Bahaaeldin Labib³, Marwa Othman⁴, Lalu Chacko⁴, Daphne Mae⁴, Lamiaa Elnour⁴, Rami H Al-Rifai⁵

Affiliations

¹ Department of Pediatric, Burjeel Hospital, Abu Dhabi, United Arab Emirates.
² Pediatric Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
³ Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
⁴ Burjeel Hospital, Abu Dhabi, United Arab Emirates.
⁵ Institute of Public Health, College of Medicine and Health Sciences, Al Ain, United Arab Emirates.

Abstract

Objective: This study investigated clinical and laboratory differences between confirmed (RT-PCR-positive) and clinically suspected (RT-PCR-negative) COVID-19 pediatric patients, and explored factors associated with disease severity at presentation and duration of hospitalization.

Methods: Medical charts of COVID-19-confirmed and clinically suspected pediatric patients admitted to a tertiary hospital in Abu Dhabi were reviewed. Sociodemographic information and clinical and laboratory outcomes were retrieved and analyzed.

Results: Between 1 April to 30 June, 2020, 173 patients (mean age: 3.6 ± SD 3.2 years) presented with respiratory symptoms. Of them, 18.0% had confirmed contact with COVID-19 cases, 66.5% had symptoms for ≤3 days, and 86.7% were with moderate to severe disease. Twenty-eight (16.1%) patients tested positive while the rest (83.8%) tested negative in RT-PCR. COVID-19-confirmed and clinically suspected patients were statistically similar (p > 0.05) in all sociodemographic data, disease severity, and vital signs except residence status (89.3% vs. 58.6% were residents, respectively, p = 0.002) and contact with confirmed COVID-19 cases (82.1% vs. 5.5%, respectively, p < 0.001). Fever (100 and 91.0%) and cough (100 and 95.9%) were the most common symptoms in both confirmed and clinically suspected COVID-19 patients. All patients were statistically comparable in mean white blood cell and platelet counts and hemoglobin concentration, except in mean concentration of neutrophils (higher in clinically suspected, p = 0.019). C-reactive protein was two times higher in clinically suspected compared to confirmed patients (p = 0.043). Lymphocyte (OR: 1.31, p < 0.001), LDH (OR: 1.01, p = 0.001), D-dimer (OR: 1.92, p < 0.001), and ferritin levels after 24-36 h (OR: 9.25, p < 0.05), and SGPT (OR: 1.04, p < 0.05) were all associated with disease severity. Elevated ferritin (>300 μg/L) after 24-36 h was the only correlated factor with disease severity (aOR: 17.38, p < 0.05). Confirmed compared with clinically suspected patients (aOR: 4.00, 95% CI: 2.92-5.10) and children with moderate compared with mild disease (aOR: 5.87, 95% CI: 1.08-32.06) had longer hospitalization.

Conclusion: In pediatric patients with negative RT-PCR, COVID-19 is still suspected based on clinical symptoms and epidemiological data. A tentative diagnosis can be made based on a thorough examination, and proper medical management can be initiated promptly.

Keywords: COVID-19; SARS-CoV-2; United Arab Emirates; children; pediatrics.