The Outcome of Hospitalized Children with COVID-19 in a Referral Center in Yazd, Iran

Document Type : Original Article


1 Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Center of Healthcare Data Modelling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.


As there is limited research on COVID-19 in children, and reports have indicated low adverse clinical outcomes and mortality rates, our team conducted this study to investigate the clinical outcomes in hospitalized children with COVID-19.
Materials and Methods:
This historical cohort study included children aged 1 month to 18 years with COVID-19. They were admitted to a referral hospital in Yazd, Iran, over a year from February 2020. Demographic information such as age and sex, the length of hospitalization, and the reverse transcription-polymerase chain reaction (PCR) test results were recorded. We also evaluated Patients' outcomes, including admission to the pediatric intensive care unit (PICU), need for mechanical ventilation, and mortality.
Our study included 94 patients, of which 52.1% were female and 29.8% were under one year old. Children aged 1-59 months accounted for more than half of the sample (53.2%). The most common symptoms reported were fever (85.1%), respiratory problems (47.9%), and gastrointestinal symptoms (46.8%). The mean duration of hospital stay was 6.4±5.7 days. About 38.3% of cases required admission to the PICU, and 11.7% needed mechanical ventilation. 75% of deaths occurred in children with confirmed COVID-19 who had an underlying disease. Moreover, respiratory distress at the time of referral was significantly associated with admission to the intensive care unit (P=0.008), requiring mechanical ventilation (P=0.003), and mortality (P=0.02).
Our findings suggest that children under one year old, patients with underlying diseases, and those experiencing respiratory distress at the time of referral are high-risk groups and require special attention in care and treatment.


Main Subjects

  1. Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Archives of disease in childhood. 2021 May 1;106(5):440-8.
  2. Bahrami A, Vafapour M, Moazzami B, Rezaei N. Hyperinflammatory shock related to COVID‐19 in a patient presenting with multisystem inflammatory syndrome in children: first case from Iran. Journal of paediatrics and child health. 2021 Jun;57(6):922.
  3. Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G, et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Scientific reports. 2021 May 13; 11(1): 10231.
  4. Duarte-Salles T, Vizcaya D, Pistillo A, Casajust P, Sena AG, Lai LY, et al. Thirty-day outcomes of children and adolescents with COVID-19: an international experience. Pediatrics. 2021 Sep 1; 148(3).
  5. Eastin C, Eastin T. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China: Dong Y, Mo X, Hu Y, Pediatrics. 2020. Journal of Emergency Medicine. 2020 Apr 1;58(4):712-3.
  6. Bhalala US, Gist KM, Tripathi S, Boman K, Kumar VK, Retford L, et al. Characterization and outcomes of hospitalized children with coronavirus disease 2019: a report from a multicenter, viral infection and respiratory illness universal study (coronavirus disease 2019) registry.Critical care medicine.2022Jan;50(1): e40.
  7. Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Carducci FI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. The Lancet Child & Adolescent Health. 2020 Sep 1;4(9):653-61.
  8. Cristiani L, Mancino E, Matera L, Nenna R, Pierangeli A, Scagnolari C, et al. Will children reveal their secret? The coronavirus dilemma. European respiratory journal. 2020 Apr 1;55(4).
  9. Dhochak N, Singhal T, Kabra SK, Lodha R. Pathophysiology of COVID-19: why children fare better than adults?. The Indian Journal of Pediatrics. 2020 Jul;87:537-46.
  10. Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA pediatrics. 2021 Mar 1;175(3):316-7.
  11. Shahbaznejad L, Rouhanizadeh H, Navaeifar MR, Hosseinzadeh F, Movahedi FS, Rezai MS. Clinical characteristics and outcomes of COVID-19 in children in Northern Iran. International journal of pediatrics. 2021 Apr 28;2021:1-6.
  12. Madani S, Shahin S, Yoosefi M, Ahmadi N, Ghasemi E, Koolaji S, et al. Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran. BMC pediatrics. 2021 Dec 10;21(1):563.
  13. Mahmoudi S, Mehdizadeh M, Shervin Badv R, Navaeian A, Pourakbari B, Rostamyan M, et al. The coronavirus disease 2019 (COVID-19) in children: a study in an Iranian Children’s Referral Hospital. Infection and drug resistance.2020 Jul31:2649-55.
  14. Woodruff RC, Campbell AP, Taylor CA, Chai SJ, Kawasaki B, Meek J, et al. Risk factors for severe COVID-19 in children. Pediatrics. 2022 Jan 1; 149(1): e2021053418.
  15. Garazzino S, Montagnani C, Donà D, Meini A, Felici E, Vergine G, et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Eurosurveillance. 2020 May 7;25(18): 2000600.
  16. Alharbi M, Kazzaz YM, Hameed T, Alqanatish J, Alkhalaf H, Alsadoon A, et al. SARS-CoV-2 infection in children, clinical characteristics, diagnostic findings and therapeutic interventions at a tertiary care center in Riyadh, Saudi Arabia. Journal of Infection and Public Health. 2021 Apr 1;14(4):446-53.
  17. Liu W, Zhang QI, Chen J, Xiang R, Song H, Shu S, Chen L, et al. Detection of Covid-19 in children in early January 2020 in Wuhan, China. New England Journal of Medicine. 2020 Apr 2;382(14):1370-1.
  18. Jiehao C, Jin X, Daojiong L, Zhi Y, Lei X, Zhenghai Q, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical Infectious Diseases. 2020 Sep 15;71(6):1547-51.
  19. García-Salido A, Leoz-Gordillo I, de Azagra-Garde AM, Nieto-Moro M, Iglesias-Bouzas MI, García-Teresa MÁ, et al. Children in critical care due to severe acute respiratory syndrome coronavirus 2 infection: experience in a Spanish hospital. Pediatric Critical Care Medicine. 2020 Aug;21(8):e576.
  20. Swann OV, Holden KA, Turtle L, Pollock L, Fairfield CJ, Drake TM, Set al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. bmj. 2020 Aug 27;370.
  21. Derespina KR, Kaushik S, Plichta A, Conway Jr EE, Bercow A, Choi J, Eisenberg R,et al. Clinical manifestations and outcomes of critically ill children and adolescents with coronavirus disease 2019 in New York City. The Journal of pediatrics. 2020 Nov 1;226:55-63.