Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: A cross-sectional study, Italy, 23 February to 24 May 2020

M. Lazzerini, I. Sforzi, S. Trapani, P. Biban, D. Silvagni, G. Villa, J. Tibaldi, L. Bertacca, E. Felici, G. Perricone, R. Parrino, C. Gioè, S. Lega, M. Conte, F. Marchetti, A. Magista, P. Berlese, S. Martelossi, F. Vaienti, E. VallettaM. Mauro, R. Dall'Amico, S. Fasoli, A. Gatto, A. Chiaretti, D. Dragovic, P. Pascolo, C. Pilotto, I. Liguoro, E. Miorin, F. Saretta, G.L. Trobia, A. Di Stefano, A. Orlandi, F. Cardinale, R. Lubrano, A. Testa, M. Binotti, V. Moressa, E. Barbi, B. Armocida, I. Mariani, COVID-19 Italian Pediatric Study Network

Research output: Contribution to journalArticlepeer-review


Background: Very few studies describe factors associated with COVID-19 diagnosis in children. Aim: We here describe characteristics and risk factors for COVID-19 diagnosis in children tested in 20 paediatric centres across Italy. Methods: We included cases aged 0-18 years tested between 23 February and 24 May 2020. Our primary analysis focused on children tested because of symptoms/signs suggestive of COVID-19. Results: Among 2,494 children tested, 2,148 (86.1%) had symptoms suggestive of COVID-19. Clinical presentation of confirmed COVID-19 cases included besides fever (82.4%) and respiratory signs or symptoms (60.4%) also gastrointestinal (18.2%), neurological (18.9%), cutaneous (3.8%) and other unspecific influenza-like presentations (17.8%). In multivariate analysis, factors significantly associated with SARSCoV-2 positivity were: exposure history (adjusted odds ratio (AOR): 39.83; 95% confidence interval (CI): 17.52-90.55; p<0.0001), cardiac disease (AOR: 3.10; 95% CI: 1.19-5.02; p<0.0001), fever (AOR: 3.05%; 95% CI: 1.67-5.58; p=0.0003) and anosmia/ ageusia (AOR: 4.08; 95% CI: 1.69-9.84; p=0.002). Among 190 (7.6%) children positive for SARS-CoV-2, only four (2.1%) required respiratory support and two (1.1%) were admitted to intensive care; all recovered. Conclusion: Recommendations for SARS-CoV-2 testing in children should consider the evidence of broader clinical features. Exposure history, fever and anosmia/ ageusia are strong risk factors in children for positive SARS-CoV-2 testing, while other symptoms did not help discriminate positive from negative individuals. This study confirms that COVID-19 was a mild disease in the general paediatric population in Italy. Further studies are needed to understand risk, clinical spectrum and outcomes of COVID-19 in children with preexisting conditions.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
Issue number14
Publication statusPublished - 2021


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