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Background Currently published data on COVID-19 in children remain very limited, and most reports originate from China. This study aimed to capture key data on children with SARS-CoV-2 infection across Europe to inform physicians and healthcare services. Methods Multi-center study involving 80 participating healthcare institutions across 25 European countries, using a well-established Pediatric TB research network predominately comprising Pediatric Infectious Diseases specialists and Pediatric Pulmonologists, over a 3.5-week period in April 2020, at the peak of the European COVID-19 pandemic. Results A total of 590 PCR-confirmed cases were included [median age: 5.0 years (IQR:0.5-12.0)]. One-hundred forty-six (24.7%) had significant pre-existing medical conditions. The majority (n=366;62.0%) were admitted to hospital. Forty-eight (8.1%) required intensive care unit (ICU) support, 25 (4.4%) mechanical ventilation (median duration:7 days; range:1-34 days), 19 (3.2%) inotropic support, and one (0.1%) extracorporeal-membrane-oxygenation. Significant risk factors for requiring ICU support in multivariate analyses were age <1 month, male gender, pre-existing medical condition, and presence of lower respiratory tract symptoms at presentation. The most frequently used drug was hydroxychloroquine, followed by remdesivir, lopinavir/ritonavir and oseltamivir. Immunomodulatory medication used included corticosteroids, intravenous immunoglobulin, tocilizumab, anakinra and siltuximab. Four children died (case fatality rate:0.68%; 95%CI:0.20-1.80%); the remaining 586 survived without apparent sequelae. Conclusions COVID-19 is generally a mild disease in children, including in infants. However, a small proportion develop severe disease requiring ICU support and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, indicating that additional data on antiviral and immunomodulatory drugs are needed urgently.


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