Clinical Presentation of COVID-19 and Correlation of Severity with Laboratory Parameters among Children Admitted with Severe Acute Respiratory InfectionAn Observational Study

Introduction: On March, 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In adults it causes mild to severe infections, but in children it usually causes asymptomatic or mild illness. Being a new pandemic, it is prudent to analyse the clinical profile, laboratory parameters and severity interpreters in children to formulate optimal management protocols. Aim: To determine the clinical and laboratory profile of children hospitalised for Severe Acute Respiratory Infections (SARI) and to evaluate the correlation between clinical severity and laboratory parameters- C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) and thrombocytopenia. Materials and Methods: The present study was a prospective observational study which was undertaken for the duration of seven months from 1st April to 30th November 2020. The study included children aged 1 month to 12 years with the criteria of SARI and who were Coronavirus Disease-2019 (COVID-19) positive. Test parameters such as Complete Blood Count (CBC), CRP, serum electrolytes and kidney function tests were performed at local laboratory as per standard guidelines. The correlation of laboratory parameters (thrombocytopenia, CRP and NLR) with disease severity was done with Pearson’s Rho correlation coefficient. Chi-square test was used for statistical analysis. Results: A total of 118 (10.2%) children were tested positive for COVID-19, 71 (60.17%) were boys and 47 (39.83%) were girls. The commonest clinical symptoms were fever and tachypnea. Gastrointestinal symptoms were found in 54 (45.76%) of the cases. Myocarditis and shock were noticed in 10 (8.47%) children. In 25 (59.52%) of severe COVID-19 cases, NLR was >3.5 and 18 (42.86%) had thrombocytopenia. Seventeen children died of the disease with a mortality rate of 14.41%. Platelet count and NLR ratios were significantly correlated with disease severity (p≤0.05). Conclusion: Markers such as NLR and thrombocytopenia which can be used efficiently to assess the severity even in low resource settings, are relevant to a developing country like India. The ratio of neutrophils to lymphocytes can be used as a prognostic marker in resource-constrained settings.