Background: There is evolving evidence of significant differences in severity and outcomes of coronavirus disease 2019 (COVID-19) in children compared to adults. Underlying medical conditions associated with increased risk of severe disease are based on adult data, but have been applied across all ages resulting in large numbers of families undertaking social shielding (vulnerable group). We conducted a retrospective analysis of children with suspected COVID-19 at a Specialist Childrens Hospital to determine outcomes based on COVID-19 testing status and underlying health vulnerabilities. Methods: Routine clinical data were extracted retrospectively from the Institutions Electronic Health Record system and Digital Research Environment for patients with suspected and confirmed COVID-19 diagnoses. Data were compared between Sars-CoV-2 positive and negative patients (CoVPos / CoVNeg respectively), and in relation to presence of underlying health vulnerabilities based on Public Health England guidance. Findings: Between 1st March and 15th May 2020, 166 children (<18 years of age) presented to a specialist childrens hospital with clinical features of possible COVID-19 infection. 65 patients (39.2%) tested positive for SARS-CoV-2 virus. CoVPos patients were older (median 9 [0.9-14] years vs median 1 [0.1-5.7.5] years respectively, p<0.001). There was a significantly reduced proportion of vulnerable cases (47.7% vs 72.3%, p=0.002), but no difference in proportion of vulnerable patients requiring ventilation (61% vs 64.3%, p = 0.84) between CoVPos and CoVNeg groups. However, a significantly lower proportion of CoVPos patients required mechanical ventilation support compared to CoVNeg patients (27.7 vs 57.4%, p<0.001). Mortality was not significantly different between CoVPos and CoVNeg groups (1.5 vs 4% respectively, p=0.67) although there were no direct COVID-19 related deaths in this highly preselected paediatric population. Interpretation: COVID-19 infection may be associated with severe disease in childhood presenting to a specialist hospital, but does not appear significantly different in severity to other causes of similar clinical presentations. In children presenting with pre-existing COVID-19 vulnerable medical conditions at a specialist centre, there does not appear to be significantly increased risk of either contracting COVID-19 or severe complications, apart from those undergoing chemotherapy, who are over-represented.

中文翻译：

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专家中心儿童的冠状病毒（COVID-19）感染：儿童人群中潜在的高危合并症的结果和影响

背景：有不断发展的证据表明，与成年人相比，儿童的冠状病毒病2019（COVID-19）的严重程度和预后显着不同。与严重疾病风险增加相关的潜在医学状况基于成人数据，但已应用于各个年龄段，导致大量家庭受到社会庇护（弱势群体）。我们在一家专科儿童医院对疑似COVID-19的儿童进行了回顾性分析，以确定基于COVID-19测试状态和潜在健康漏洞的结果。方法：回顾性地从机构电子健康记录系统和数字研究环境中提取可疑和确诊为COVID-19的患者的常规临床数据。根据英国公共卫生指南，比较了Sars-CoV-2阳性和阴性患者（分别为CoVPos / CoVNeg）的数据以及与潜在健康漏洞的相关性。结果：在2020年3月1日至5月15日之间，有166例儿童（<18岁）被送往儿童专科医院，其临床特征可能是感染了COVID-19。65位患者（39.2％）检测出SARS-CoV-2病毒呈阳性。CoVPos患者年龄较大（中位数为9 [0.9-14]岁，中位数为1 [0.1-5.7.5]岁，p <0.001）。CoVPos和CoVNeg组之间的弱势病例比例显着降低（47.7％vs 72.3％，p = 0.002），但需要通气的弱势患者比例没有差异（61％vs 64.3％，p = 0.84）。然而，与CoVNeg患者相比，CoVPos患者需要机械通气支持的比例显着降低（27.7 vs 57.4％，p <0.001）。尽管在这个高度预选的儿科人群中没有直接的与COVID-19相关的死亡，但CoVPos和CoVNeg组之间的死亡率无显着差异（分别为1.5％和4％，p = 0.67）。解释：到专科医院就诊时，COVID-19感染可能与儿童时期的严重疾病有关，但在严重程度上与其他类似临床表现的其他原因并没有显着差异。在专科中心出现COVID-19易患病的儿童中，除正在接受化疗的儿童外，患COVID-19或发生严重并发症的风险似乎没有显着增加，