Are COVID-19 infected children with gastrointestinal symptoms different from those without symptoms? A comparative study of the clinical characteristics and epidemiological trend of 244 pediatric cases from Wuhan

Objective

COVID-19 patients presenting with gastrointestinal (GI) symptoms occur in both adults and children. To date, however, no large sample size study focusing on gastrointestinal symptoms in pediatric cases has been published. We analyzed COVID-19 infected children in Wuhan who presented with initial GI symptoms to determine the GI characteristics and epidemiological trend of the disease.

Design

We retrospectively analyzed 244 children patients confirmed with COVID-19 at Wuhan Children’s Hospital from 21 Jan to 20 Mar 2020. Symptomatic cases were divided into two groups according to whether the patients presented with or without GI symptoms on admission. Demographic, epidemiological, symptoms, and laboratory data were compared. We also analyzed the respective trends of case number changes of GI cases and asymptomatic cases.

Results

34 out of 193 symptomatic children had GI symptoms. They had lower median age and weight, a higher rate of fever, a longer length of stay and more hematological and biochemical abnormalities than patients without GI symptoms. There was no significant difference in chest CT findings or stool SARS-CoV-2 test positive percentages between the two groups. The number of patients admitted with GI symptoms showed an overall downward trend with time. At the time of writing, 242 patients were discharged, one died, and one critically ill patient was still in the intensive care unit.

Conclusion

COVID-19 infected children with GI symptoms are prone to presenting with more clinical and laboratory abnormalities than patients without GI symptoms. More attention and timely hospital admission are needed for these patients.

Significance of this study

What is already known on this subject?

• COVID-19 is now a pandemic with more than 1.6 million people infected worldwide

• Although attacking the respiratory tract mostly, both adult and children infected with COVID-19 can present with GI symptoms

What are the new findings?

• Infants younger than two years old and presence of fever are the two risk factors of presenting with GI symptoms

• A high proportion of patients without GI symptoms and asymptomatic patients will have positive RT-PCR for the virus in stool

• Earlier testing through contact screening of family members means more COVID-19 infected children are diagnosed when completely asymptomatic

How might it impact on clinical practice in the foreseeable future?

• The presence of COVID-19 in stool in infected children will have a major implication for parents and carers of young infants

• Increasing number of asymptomatic COVID-19 patients who are detected through screening could provide a useful lesson for other countries still experiencing the rise and peak of the pandemic