{'fraction_non_alphanumeric': 0.05949367088607595, 'fraction_numerical': 0.0490506329113924, 'mean_word_length': 4.747272727272727, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Characteristics of 64 Children with Coronavirus Disease 2019: A Multicenter Retrospective Cohort Study Inside and Outside Wuhan China

Background: Although coronavirus disease 2019 (COVID-19) has been a disaster for the whole world now, features of children with COVID-19 are out of reach. We aim to explore the characteristics of children COVID-19 and try to shed light on the diagnosis and treatment of the disease. 
 
Methods: 64 children (aged 0-18 years) COVID-19 from six hospitals in China during the early outbreak stage were included in this study. We retrospectively grouped according to the severity of the disease, obtained information from electronic medical records, and compared the epidemiology, clinical symptoms, imaging, laboratory examination and treatment. Meanwhile, we made a comparison between different age groups, as well as between adults and children. 
 
Results: All enrolled confirmed children (mean age 7.16 [SD 5.27] years) COVID-19 presented date from Jan 15 to Feb 29, 2020. Of all 64 patients, 33 (51.6%) were female. All children were divided into asymptomatic (12), mild (12), moderate (39) and severe (1) groups. Fever (31[48.4%]) and dry cough (10[15.6%]) were the most common symptoms and the gastrointestinal symptoms were rare (four [6.3%]). Patients under 5 years old (3/26 [11.5%]) may have nasal obstruction. White blood cells (WBC) could be normal (34[53.1%]) or decreased in children with COVID-19. (17/40[42.4%]) cases’ Interleukin 6 (IL-6) were raised up especially in the moderate and severe groups. Possible indicators that could be used to evaluate the severity of the disease are lactate dehydrogenase (LDH) (19/40[47.5%]) and D-dimer (11/40[27.5%]) including IL-6. Ground glass opacity (18/40[40%]) was a characteristic change of COVID-19 imaging in the moderate and severe groups. Creatine kinases MB (CK-MB) (10/23 [43.4%]) and aspartate amino transferase (AST) (6/25 [24%]) may be biomarks for early hints with cardiac complications in patients aged 0-5 years. Furthermore, (11/64[17.2%]) cases were co-infected or pre-infected with other respiratory pathogens. 
 
Conclusions: The symptoms and computed tomography (CT) of children COVID-19 are not so typical as adults. Mostly of our cohort cases were moderate type and one child was severe type. Constitutional and respiratory symptoms are the mostly clinical features of children COVID-19. So, if the severe cases of children raised or other system symptoms dominantly occurred, other pathogens should be considered. Moreover IL-6 would be an indicator for the development to severe cases as well as D-dimer and LDH. AST and CK-MB will promise the severe inclining complicating heart disease. 
 
Funding Statement: This study was supported by Technology Project of Guangzhou City, Grant Award Number: 201607010123. 
 
Declaration of Interests: The authors have no conflicts of interest to disclose. 
 
Ethics Approval Statement: This study was reviewed and approved by the Medical Ethical Committee of General Hospital of Southern Theater Command of Chinese People's Liberation Army (approval number 2020-04). The written informed consent was waived.