Characteristics of immune and inflammatory responses among different age groups of pediatric patients with COVID-19 in China

Abstract

Severe cases of coronavirus disease 2019 (COVID-19) among pediatric patients are more common in children less than 1 year of age. Our aim is to address the underlying role of immunity and inflammation conditions among different age groups of pediatric patients. We recruited pediatric patients confirmed of moderate COVID-19 symptoms, admitted to Wuhan Children s Hospital from January 28th to April 1st in 2020. Patients were divided into four age groups (≤\u20091, 1–6, 7–10, and 11–15 years). Demographic information, clinical characteristics, laboratory results of lymphocyte subsets test, immune and inflammation related markers were all evaluated. Analysis included 217/241 (90.0%) of patients with moderate clinical stage disease. Average recovery time of children more than 6 years old was significantly shorter than of children younger than 6 years (P\u2009=\u20090.001). Reduced neutrophils and increased lymphocytes were significantly most observed among patients under 1 year old (P < 0.01). CD19+ B cells were the only significantly elevated immune cells, especially among patients under 1 year old (cell proportion: n\u2009=\u200912, 30.0%, P < 0.001; cell count: n\u2009=\u200913, 32.5%, P < 0.001). While, low levels of immune related makers, such as immunoglobulin (Ig) G (P < 0.001), IgA (P < 0.001), IgM (P < 0.001) and serum complement C3c (P < 0.001), were also mostly found among patients under 1 year old, together with elevated levels of inflammation related markers, such as tumor necrosis factor γ (P\u2009=\u20090.007), interleukin (IL)-10 (P\u2009=\u20090.011), IL-6 (P\u2009=\u20090.008), lactate dehydrogenase (P < 0.001), and procalcitonin (P\u2009=\u20090.007). The higher rate of severe cases and long course of COVID-19 among children under 1 year old may be due to the lower production of antibodies and serum complements of in this age group.