Pediatric Dilemma of the Third Wave Pandemic of COVID-19 in A Tertiary Care Hospital for Children

Background: In February 2020, a novel coronavirus caused a pandemic affecting children and adults with different presentations and outcomes. Objectives: The current study aimed to provide descriptive values regarding the clinical and laboratory profiles of children suspected of coronavirus disease 2019 (COVID-19). This purpose was achieved by studying all presentations, whether clinical or laboratory, typical or atypical, of suspected COVID-19-affected children at the peak of the third wave in a large tertiary hospital. Methods: This cross-sectional study enrolled 404 children with suspected COVID-19 who were tested in the Emergency Room of Abu El-Reesh Japanese Hospital, Cairo, Egypt, during the study period, which was from March 2021 to the end of October 2021. According to age, the patients were divided into four groups, including those under 2 years, the early childhood group (2 - 6 years), the late childhood group (6 - 12 years), and those over 12 years. The enrolled cases met the diagnostic criteria for COVID-19 according to the Egyptian Ministry of Health protocol. Results: In this study, 58 out of 404 tested children were positive for COVID-19 (14%), with a higher male predominance (n = 230/404, or 56.9% of the study group). The median age of the study participants was 1.6 years. Out of all presentations, the non-respiratory ones predominated and had the upper hand. It represented 62.9% (254/404) of the total presentations of the enrolled children. Among the non-respiratory manifestations, gastrointestinal ones were predominant (n = 63). Thrombocytopenia, leucopenia, and pancytopenia were significantly higher in children with non-respiratory manifestations than in those with respiratory manifestations. Conclusions: Children might have atypical manifestations of COVID-19 infections. The non-respiratory system could predominate in children. Thrombocytopenia could be a laboratory marker for COVID-19 infection, especially in those with predominant non-respiratory manifestations. Respiratory manifestations in children could be a guide for other systemic affections.