Clinical features
The clinical presentation of COVID-19 in neonates and children is typically mild and exhibits similarities across different countries (Shen K et al.,2020 ; Zhu H et al.2020). Children most frequently require hospitalization due to symptoms such as fever and respiratory issues, including cough, sore throat, facial flushing, nasal congestion, rapid breathing or difficulty breathing (tachypnea/dyspnea), and an elevated heart rate (tachycardia) (Tagarro A et al., 2021; Parri N et al., 2020). In rare instances, neurological symptoms such as seizures, dystonia, and altered mental status have also been documented (Dugue R et al., 2020).
COVID-19 severity categories, encompassing asymptomatic infections, mild, moderate, severe, and critical cases, were defined based on clinical features, laboratory tests, and X-ray imaging criteria, (Dong Y et al., 2020). While lymphocytopenia was observed frequently in adults with severe COVID-19 and correlated with adverse outcomes, this is not typically the case in children, likely due to the higher percentage of lymphocytes in individuals of that particular age group (Henry BM et al.,2020; Li H et al. 2020). On the other hand, adults displayed significantly elevated levels of D-Dimer, ferritin, and coagulopathy, whereas these manifestations were rarely observed in children, (Sun D et al.; 2020).
The majority of these laboratory irregularities observed in children lack specificity. It was noted that 69.2% of children had leukocyte counts within the normal range, and instances of neutrophilia or neutropenia were infrequent (occurring in less than 5% of cases). Platelet counts exhibited variability across different studies, generally trending higher than the normal range. Additionally, C-reactive protein levels were elevated in 13.6% of cases, while procalcitonin levels were increased in 10.6% of cases ( Henry BM et al., 2020).