The impact of COVID-19 on children and clinical paediatric care in Munich: an observational study during the first wave of the 2020 pandemic

Kaltenhauser, Carola (2023): The impact of COVID-19 on children and clinical paediatric care in Munich: an observational study during the first wave of the 2020 pandemic. Dissertation, LMU München: Medizinische Fakultät

Abstract

While significant research has been conducted to examine the impact COVID-19 had on adults during the early phases of the ongoing pandemic, the extent to which children were affected remains largely unexplored. This thesis presents data on how the clinical care of the children’s hospital of the Ludwig-Maximilians-University (LMU) in Munich was affected during the first wave of the pandemic (March to May 2020) and provides a qualitative description of how COVID-19 manifested in children. Additionally, preliminary clinical parameters as potential predictors for the development of severe COVD-19 in children are presented. To do so, data from the paediatric hospital were collected, and a cohort of 12 hospitalised children with COVID-19 was recruited and observed. During the first wave of the SARS-CoV-2 pandemic in 2020, the total number of children presented at the paediatric care in Munich (LMU) decreased by approximately 40% in comparison to the same time period in 2019 (P=.017), and the number of children admitted due to common infectious diseases (such as respiratory or gastrointestinal infections other than COVID-19) decreased by 74% (P=.013). In context of nationally overrun and exhausted health care systems, these findings indicate that children were less impacted by the first wave of the pandemic in comparison to older age groups. Of the children that were admitted to Munich’s paediatric hospitals due to a SARS-CoV-2 infection during the first wave, the majority (58%) presented with mild symptoms such as fever, cough and rhinitis. Two children within the cohort developed life-threatening severe hyperinflammatory syndromes such as PIMS and sHLH with ARDS, while three children remained asymptomatic during their entire period of infection. On the basis of 12 hospitalised patients, the following factors can be described to be potentially associated with having a higher risk of developing a severe course of COVID-19 in children: young age (mean=2 years), pre-existing conditions including congenital heart diseases (PFO, ASD II and AVSD) or Down Syndrome. Additionally, the following clinical parameters were observed in children with a severe course of disease: highly elevated levels of IL-6, IL-2, CRP and Procalcitonin, occurrence of emesis, longer duration of fever, development of hyperinflammatory syndromes (sHLH, PIMS), prolonged duration of hospitalisation and treatment with IVIG and corticosteroids. The small cohort size (n=12) associated to the low hospitalisation rates of children in the first wave, was insufficient to identify statistically significant predictors for developing a severe course of COVID-19 and only provide the description of the observations we made in this period of time. This remains subject of ongoing research within the hospital following an immunological and genetic approach.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 26. Juli 2023
• 1. Bericht­erstatter:in: Hübner, Johannes