Clinical features and disease severity across immune status in pediatric patients with COVID-19

BACKGROUND:
COVID-19 pandemic has caused a major global health disruption. Pediatric presentations vary widely, particularly among children with differing immune status.


OBJECTIVES:
To compare the clinical presentation, disease course, and outcomes of immunocompetent versus immunocompromised pediatric patients with COVID-19 in a tertiary referral hospital in Jeddah, Saudi Arabia.


DESIGN:
Retrospective chart review


SETTINGS:
A tertiary center treating immunocompromised children including those with HIV, solid and hematologic malignancies, and solid organ or hematopoietic stem cell transplantation.


PATIENTS AND METHODS:

Records of 123 pediatric patients (<15 years) with confirmed COVID-19 from March 2020 to March 2021 were reviewed. Demographic, clinical, laboratory, radiologic, and treatment variables were extracted and compared between immunocompetent and immunocompromised patients. Chi-square testing was used with significance set at
P
<.05. Immunocompromised status was defined as the presence of an underlying medical condition or treatment associated with clinically significant immune suppression



MAIN OUTCOME MEASURES:
Differences in symptoms, severity, clinical progression, and outcomes between immunocompetent and immunocompromised children.


SAMPLE SIZE:
123 children


RESULTS:

Most patients were immunocompetent (93, 75.6%). Immunocompromised children primarily included post-transplant or oncology patients on chemotherapy. Fever was the most common presenting symptom (69, 56.1%), significantly more common in immunocompetent children (
P
=.029). Immunocompromised children were more frequently admitted, mainly for non-COVID-related concerns (e.g., abnormal chest radiograph, febrile neutropenia, or hydration). Nearly all patients recovered without complications, and no significant difference in recovery rate was observed between groups (
P
=.568).



CONCLUSION:
COVID-19 severity and recovery appeared similar between immunocompetent and immunocompromised pediatric patients in this cohort. However, the higher hospitalization rate observed among immunocompromised children likely reflects precautionary admission practices rather than increased disease severity. Findings should be interpreted cautiously given the small immunocompromised subgroup and heterogeneity of underlying conditions. Interpretation of these findings is limited by the retrospective design and relatively small sample size. Larger multicenter studies are required to confirm these observations.