We collected patient demographics, ethnicity, Body Mass Index (BMI), length of admission, background clinical conditions, symptoms at presentation, biochemical markers, complications and mortality. This patient sample has been utilized in another publication, British Medical Journal, Paediatrics open 2021, Clinical manifestation and outcome in children with COVID-19 infection in Abu Dhabi: a retrospective single centre study. Patients were reviewed by a pediatrician daily and were discharged if they had two negative COVID-19 PCR test 48 h apart and were medically fit for discharge. ![]() At the start of the pandemic all paediatric patients were admitted to hospital, Sheikh Khalifa Medical City (the only designated pediatric COVID-19 Hospital in Abu Dhabi City for children) to ensure appropriate isolation measures are carried out and the medical needs of the children are met. This study was conducted at the start of the pandemic. We retrospectively reviewed the electronic medical records of patients with COVID-19 diagnosed based on nasal swab PCR aged 0–18 years old from 1st of March to 1st of June 2020. We aim to review GI symptoms and liver injury in children with COVID-19, to evaluate risk factors predisposing for GI symptoms, and to assess if GI symptoms and liver injury are associated with more severe COVID-19 disease in our population.Īpproval from the Institutional Review Board Committee for COVID-19 research in the Department of Health, Abu Dhabi was obtained. They performed Polymerase Chain Reaction (PCR) nasal swab tests of 2,850 per 100,000 population per day ( 11), achieving identification and isolation of most paediatric COVID-19 infected children. The United Arab Emirates (UAE) developed a strong testing program. Children with GI symptoms show higher levels of C-reactive protein and procalcitonin this suggests that more severe COVID disease is observed with GI symptoms in children ( 15). In addition, gastrointestinal symptoms are observed more frequently in children with younger age and fever ( 14). GI symptoms are reported to range from 12% to 21% in the pediatric literature with varying frequencies in the United States, Europe and China ( 11– 13). The viral shedding in stool and nasal secretions make children possible facilitators of viral transmission ( 5) and is one of the possible explanations for the prevalence of Gastrointestinal (GI) symptoms in CVOID-19 infected children. Viral fecal shedding for several weeks after diagnosis has been reported ( 10), COVID-19 virus was observed in rectal swabs in eight out of ten children after nasopharyngeal swabs returned negative ( 11). In addition, liver injury is well described in children with COVID-19 infection. A proportion of affected patients also have digestive manifestations, such as anorexia, nausea, vomiting, diarrhea, and abdominal pain. The typical presentation of COVID-19 includes fever, weakness, nausea, and pulmonary symptoms such as dry cough and dyspnea. The pediatric population display a mild disease and majority (over 90%) have mild, moderate or asymptomatic disease ( 5– 8) Approximately 1% of children develop severe disease requiring admission to intensive care unit ( 9). 2.1%–5% of infected cases are children ( 3, 4). Severe acute respiratory syndrome coronavirus 2 was the cause of a series of cases with severe pneumonia initially reported in Wuhan, China ( 1, 2) declared as COVID-19 by the WHO. Children with gastrointestinal involvement in COVID-19 are more likely to demonstrate more severe disease but are not more likely to be admitted to PICU.Children with liver injury are more likely to develop fever.Children with COVID-19 displaying gastrointestinal symptoms are more likely to have fever, cough and elevated inflammatory markers.Children with COVID-19 display increased gastrointestinal symptoms when compared to adults.The symptoms in children are mainly respiratory but some display gastrointestinal symptoms.Pediatric COVID-19 cases mostly demonstrate asymptomatic, mild or moderate disease.Identifying children with gastrointestinal manifestations needs to be part of the initial screening assessment of children. ![]() We demonstrated that children with gastrointestinal symptoms and liver injury can develop more severe COVID-19 disease and are more likely to have fever, cough, and raised inflammatory markers. Additionally, gastrointestinal symptoms can be the only symptoms patients display. ![]() COVID-19 infection in children can display gastrointestinal symptoms at initial presentation.
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