Clinical Characteristics of Children with COVID-19: A Multicenter Study in the United Arab Emirates (Preprint)

BACKGROUND Coronavirus disease 2019 (COVID-19) has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on 29th January 2020.  COVID-19 has fared mildly in the pediatric population according to available literature out of early epicenters of the pandemic. To date there is a lack of published data about COVID-19 infection among children in the Arabian region. OBJECTIVE Investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. METHODS This cross-sectional multicenter study included children with confirmed COVID-19 infection admitted between March 1st and June 15th, 2020 to three large hospitals in Dubai, UAE. Serial COVID-19 polymerase chain reaction (PCR) testing was collected, and patients' demographics, pre-morbid clinical characteristics and inpatient hospital course were investigated. RESULTS 111 children were included in our study and represented 22 nationalities. Fifty-nine (53.2%) were boys. The mean age was 7 years (±5.3). 15.3% of children were younger than 1 year. Only 4 (3.6%) of the patients had pre-existing asthma all of whom had uneventful courses. At presentation 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms and none had severe illness requiring intensive care. Fever (20.7%), cough (19.8%) and rhinorrhea (15.3%) were the most common presenting symptoms and most symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (24.7%), aspartate transaminase (22.5%), alkaline phosphatase (36.7%) and lactate dehydrogenase (42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral co-infections were positive. COVID-19 PCR turned negative at a median of 10 days [6-14] after first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. CONCLUSIONS This study of COVID19 presentations and characteristics presents a first look into the burden of COVID19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms, and severe disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing and public health measures will be important to contain future outbreaks.