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2. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Author

Goetzinger, F, Santiago-Garcia, B, Noguera-Julian, A, Lanaspa, M, Lancella, L, Carducci, FIC, Gabrovska, N, Velizarova, S, Prunk, P, Osterman, V, Krivec, U, Lo Vecchio, A, Shingadia, D, Soriano-Arandes, A, Melendo, S, Lanari, M, Pierantoni, L, Wagner, N, L'Huillier, AG, Heininger, U, Ritz, N, Bandi, S, Krajcar, N, Roglic, S, Santos, M, Christiaens, C, Creuven, M, Buonsenso, D, Welch, SB, Bogyi, M, Brinkmann, F, Tebruegge, M, Goetzinger, F, Santiago-Garcia, B, Noguera-Julian, A, Lanaspa, M, Lancella, L, Carducci, FIC, Gabrovska, N, Velizarova, S, Prunk, P, Osterman, V, Krivec, U, Lo Vecchio, A, Shingadia, D, Soriano-Arandes, A, Melendo, S, Lanari, M, Pierantoni, L, Wagner, N, L'Huillier, AG, Heininger, U, Ritz, N, Bandi, S, Krajcar, N, Roglic, S, Santos, M, Christiaens, C, Creuven, M, Buonsenso, D, Welch, SB, Bogyi, M, Brinkmann, F, and Tebruegge, M

Abstract

BACKGROUND: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. METHODS: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. FINDINGS: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5-12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72-14·87; p=0·0035), male sex (2·12, 1·06-4·21; p=0·033), pre-existing medical conditions (3·27, 1·67-6·42; p=0·0015), and presence of lower respiratory tract infection signs or sy

Published
2020

4. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Author

Benoît Bernar, Astrid Rojahn, Laura Jones, Elisabeth Schölvinck, Robin Kobbe, Laura Lancella, Delane Shingadia, Fiona Shackley, Lynne McFetridge, Conor Doherty, Cornelius Rau, Nicolaus Schwerk, Oksana Kozdoba, Koen Vanden Driessche, Arnaud G L'Huillier, Jasmin Pfefferle, Srini Bandi, R Song, Andreia Ribeiro, Ivan Solovic, Jonathan P. Glenthoej, Ulrich Heininger, Susana Melendo, Tine Boiy, Uros Krivec, An Bael, Luca Pierantoni, Edda Haberlandt, Miguel Lanaspa, Noémie Wagner, Andrea Lo Vecchio, Francesc Ripoll, Lise Heilmann Jensen, Piero Valentini, Anita Niederer, Roland Berger, Nicole Ritz, Aida M. Gutiérrez-Sánchez, Christelle Christiaens, Franziska Zucol, Katy Fidler, Jolanta Bernatoniene, Anna Starshinova, Volker Strenger, Claus Klingenberg, Ilona Lind, Clare S. Murray, Angela Zacharasiewicz, Ivan Pavic, Amanda Williams, Christina Thir, Vera Chechenyeva, Karsten Kötz, Stephanie Thee, Laura Buchtala, Danilo Buonsenso, Patrick Gavin, Rimvydas Ivaškevicius, Sara Debulpaep, Francesca Ippolita Calò Carducci, Marine Creuven, Beatriz Soto, Srđan Roglić, Lola Falcón, Yvonne Beuvink, Petra Zimmermann, Petra Schelstraete, Lynne Speirs, Daniela S. Kohlfürst, Antoni Noguera-Julian, Mihhail Tistsenko, Steven B. Welch, Hanna Schmid, Anastasios Smyrnaios, Laura Minguell, Andrew Riordan, Michael Buettcher, Angelika Berger, Isabel Carvalho, Daan Van Brusselen, Inga Ivaškeviciene, Matilde Bustillo, Valentina Vilc, Folke Brinkmann, Nina Krajcar, Olaf Neth, Alicia Demirjian, Matthias Bogyi, Ulle Uustalu, Maria Tsolia, Borja Ibanez, Elisabeth Whittaker, Ariane Biebl, Irini Eleftheriou, Burkhard Simma, Petra Prunk, Borbàla Zsigmond, Veronika Osterman, Zoe Oliver, Antoni Soriano-Arandes, Ulrikka Nygaard, Marcello Lanari, Marc Tebruegge, Olga Bilogortseva, Michael Barker, Svetlana Velizarova, Florian Götzinger, Natalia Gabrovska, Begoña Santiago-García, Benhur Şirvan Çetin, Paddy McMaster, Anna Zschocke, Frances Child, Nick Makwana, Mar Santos, Group, ptbnet COVID-19 Study, Gotzinger F., Santiago-Garcia B., Noguera-Julian A., Lanaspa M., Lancella L., Calo Carducci F.I., Gabrovska N., Velizarova S., Prunk P., Osterman V., Krivec U., Lo Vecchio A., Shingadia D., Soriano-Arandes A., Melendo S., Lanari M., Pierantoni L., Wagner N., L'Huillier A.G., Heininger U., Ritz N., Bandi S., Krajcar N., Roglic S., Santos M., Christiaens C., Creuven M., Buonsenso D., Welch S.B., Bogyi M., Brinkmann F., Tebruegge M., Pfefferle J., Zacharasiewicz A., Berger A., Berger R., Strenger V., Kohlfurst D.S., Zschocke A., Bernar B., Simma B., Haberlandt E., Thir C., Biebl A., Vanden Driessche K., Boiy T., Van Brusselen D., Bael A., Debulpaep S., Schelstraete P., Pavic I., Nygaard U., Glenthoej J.P., Heilmann Jensen L., Lind I., Tistsenko M., Uustalu U., Buchtala L., Thee S., Kobbe R., Rau C., Schwerk N., Barker M., Tsolia M., Eleftheriou I., Gavin P., Kozdoba O., Zsigmond B., Valentini P., Ivaskeviciene I., Ivaskevicius R., Vilc V., Scholvinck E., Rojahn A., Smyrnaios A., Klingenberg C., Carvalho I., Ribeiro A., Starshinova A., Solovic I., Falcon L., Neth O., Minguell L., Bustillo M., Gutierrez-Sanchez A.M., Guarch Ibanez B., Ripoll F., Soto B., Kotz K., Zimmermann P., Schmid H., Zucol F., Niederer A., Buettcher M., Cetin B.S., Bilogortseva O., Chechenyeva V., Demirjian A., Shackley F., McFetridge L., Speirs L., Doherty C., Jones L., McMaster P., Murray C., Child F., Beuvink Y., Makwana N., Whittaker E., Williams A., Fidler K., Bernatoniene J., Song R., Oliver Z., Riordan A., Gotzinger, F., Santiago-Garcia, B., Noguera-Julian, A., Lanaspa, M., Lancella, L., Calo Carducci, F. I., Gabrovska, N., Velizarova, S., Prunk, P., Osterman, V., Krivec, U., Lo Vecchio, A., Shingadia, D., Soriano-Arandes, A., Melendo, S., Lanari, M., Pierantoni, L., Wagner, N., L'Huillier, A. G., Heininger, U., Ritz, N., Bandi, S., Krajcar, N., Roglic, S., Santos, M., Christiaens, C., Creuven, M., Buonsenso, D., Welch, S. B., Bogyi, M., Brinkmann, F., Tebruegge, M., Pfefferle, J., Zacharasiewicz, A., Berger, A., Berger, R., Strenger, V., Kohlfurst, D. S., Zschocke, A., Bernar, B., Simma, B., Haberlandt, E., Thir, C., Biebl, A., Vanden Driessche, K., Boiy, T., Van Brusselen, D., Bael, A., Debulpaep, S., Schelstraete, P., Pavic, I., Nygaard, U., Glenthoej, J. P., Heilmann Jensen, L., Lind, I., Tistsenko, M., Uustalu, U., Buchtala, L., Thee, S., Kobbe, R., Rau, C., Schwerk, N., Barker, M., Tsolia, M., Eleftheriou, I., Gavin, P., Kozdoba, O., Zsigmond, B., Valentini, P., Ivaskeviciene, I., Ivaskevicius, R., Vilc, V., Scholvinck, E., Rojahn, A., Smyrnaios, A., Klingenberg, C., Carvalho, I., Ribeiro, A., Starshinova, A., Solovic, I., Falcon, L., Neth, O., Minguell, L., Bustillo, M., Gutierrez-Sanchez, A. M., Guarch Ibanez, B., Ripoll, F., Soto, B., Kotz, K., Zimmermann, P., Schmid, H., Zucol, F., Niederer, A., Buettcher, M., Cetin, B. S., Bilogortseva, O., Chechenyeva, V., Demirjian, A., Shackley, F., Mcfetridge, L., Speirs, L., Doherty, C., Jones, L., Mcmaster, P., Murray, C., Child, F., Beuvink, Y., Makwana, N., Whittaker, E., Williams, A., Fidler, K., Bernatoniene, J., Song, R., Oliver, Z., and Riordan, A.

Subjects
Male, Delivery of Health Care / organization & administration, medicine.medical_treatment, Coronavirus Infections / therapy, Coronavirus Infections / epidemiology, law.invention, Patient Admission, 0302 clinical medicine, law, Risk Factors, COVID-19, children, Europe, Developmental and Educational Psychology, 030212 general & internal medicine, Child, ddc:618, Intensive care unit, Coronavirus, SARS-CoV-2, child, treatment, intensive care, Intensive Care Units, N/A, Child, Preschool, Female, Europe / epidemiology, Coronavirus Infections, Human, Cohort study, medicine.medical_specialty, Pneumonia, Viral / epidemiology, Intensive Care Unit, Pneumonia, Viral, Patient Admission / trends, Intensive Care Units / organization & administration, Article, Follow-Up Studie, 03 medical and health sciences, Betacoronavirus, 030225 pediatrics, Internal medicine, Lower respiratory tract infection, medicine, Extracorporeal membrane oxygenation, Humans, Pediatrics, Perinatology, and Child Health, Pandemics, Pneumonia, Viral / therapy, Mechanical ventilation, Betacoronaviru, Coronavirus Infection, business.industry, Risk Factor, Infant, Newborn, Infant, Odds ratio, medicine.disease, ptbnet COVID-19 Study Group, Clinical research, El Niño, Pediatrics, Perinatology and Child Health, business, Delivery of Health Care, Follow-Up Studies
Abstract

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one ( Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.

Published
2020

5. [Pediatric neuroborreliosis : diagnosis and treatment].

Author

Warnier H, Christiaens C, Creuven M, Fontaine C, and Genin C

Subjects
Anti-Bacterial Agents therapeutic use, Child, Humans, Lyme Neuroborreliosis diagnosis, Lyme Neuroborreliosis drug therapy, Meningitis drug therapy
Abstract

Neuroborreliosis is the second most frequent presentation of Lyme disease in children. Isolated facial palsy is the most classical manifestation of neuroborreliosis, but another clinical picture can be found in children: subacute meningitis, radiculoneuritis, or rarely severe neurological manifestations (transverse myelitis, encephalitis). Diagnosis and treatment guidelines of neuroborreliosis in children will be reviewed here. They are frequently discussed, especially concerning the need for lumbar puncture for diagnosis, and the choice of antibiotic regimen and administration route.

Published
2021

6. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.

Author

Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, Gabrovska N, Velizarova S, Prunk P, Osterman V, Krivec U, Lo Vecchio A, Shingadia D, Soriano-Arandes A, Melendo S, Lanari M, Pierantoni L, Wagner N, L'Huillier AG, Heininger U, Ritz N, Bandi S, Krajcar N, Roglić S, Santos M, Christiaens C, Creuven M, Buonsenso D, Welch SB, Bogyi M, Brinkmann F, and Tebruegge M

Subjects
COVID-19, Child, Child, Preschool, Coronavirus Infections therapy, Europe epidemiology, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Patient Admission trends, Pneumonia, Viral therapy, Risk Factors, SARS-CoV-2, Betacoronavirus, Coronavirus Infections epidemiology, Delivery of Health Care organization & administration, Intensive Care Units organization & administration, Pandemics, Pneumonia, Viral epidemiology
Abstract

Background: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic., Methods: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission., Findings: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5-12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72-14·87; p=0·0035), male sex (2·12, 1·06-4·21; p=0·033), pre-existing medical conditions (3·27, 1·67-6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16-21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20-1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support., Interpretation: COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed., Funding: ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Published
2020
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