Table 2.

Case definition and clinical classification of children from the Chinese updated consensus statement (March 24, 2020) (22).

CASE DEFINITION

A suspected case is defined as a case that meets: one epidemiologic criterion and two clinical criteria

Epidemiologic criteria: 1. Children with a travel or residence history in a community with infected cases reported in China or a country or region with a serious epidemic within 14 days prior to disease onset (with the global pandemic of COVID-19, imported cases deserve attention) 2. Children with a history of contacting patients infected with SARS-CoV-2 within 14 days prior to disease onset 3. Children with a history of contacting patients with fever or respiratory symptoms from communities with reported cases in China or countries or regions with serious epidemic within 14 days prior to disease onset 4. Clustered cases: two or more cases with fever and/or respiratory symptoms within 14 days in small groups (such as family members, school classmates, etc.) 5. Newborns delivered by mothers with confirmed infection.

Clinical criteria: 1. Fever, fatigue, dry cough, and/or other respiratory symptoms; some pediatric patients may have low-grade fever or no fever 2. Patients with the following chest imaging findings: single or multiple localized ground-glass opacities in the form of light cloud or fine mesh, with thickened blood vessels shadows inside the lesions; localized consolidation, located under the pleura or near the bronchial blood vessel bundles, most in the bilateral lower lobes of the periphery of the subpleural lung; increased ground-glass shadows; large-scale consolidation; diffused consolidation of unilateral or bilateral lungs, with ground-glass opacities, bronchial inflation signs 3. In the early phase of the disease, white blood cell count is normal or decreased, or with decreased lymphocytes count 4. No other pathogens are detected which can fully explain the clinical manifestations.

A confirmed case is defined as a case that meets any of the following criteria: 1. Testing positive for SARS-CoV-2 by real-time PCR 2. Genetic sequencing of respiratory tract or blood samples is highly homologous with the known SARS-CoV-2 3. Both serum-specific antibodies IgM and IgG are positive 4. Serum-specific antibody IgG changed from negative to positive or increased 4-folds or higher than that in the acute phase during the recovery period.

CLINICAL CLASSIFICATION

1. Asymptomatic infection (silent infection)     Testing positive for SARS-CoV-2, but without clinical symptoms or abnormal chest imaging findings 2. Acute upper respiratory tract infection     With only fever, cough, pharyngeal pain, nasal congestion, fatigue, headache, myalgia or discomfort, etc., and without signs of pneumonia by chest imaging or sepsis 3. Mild pneumonia     With or without fever, with respiratory symptoms such as cough; and chest imaging indicating changes of viral pneumonia, but not reaching the criteria of severe pneumonia 4. Severe pneumonia   a. Polypnea: ≥60 times/min (<2 months), ≥50 times/ min (2–12 months), ≥40 times/min (1–5 years), ≥30 times/min (>5 years) (after ruling out the effects of fever and crying)   b. Oxygen saturation <92% under a resting state   c. Dyspnea: assisted breathing (moans, nasal flaring, and three concave sign), cyanosis, intermittent apnea   d. Disturbance of consciousness: somnolence, coma, or convulsion   e. Food refusal or feeding difficulty, with signs of dehydration   f. Pulmonary high-resolution CT (HRCT) examination showing bilateral or multi-lobe infiltrates, rapid progression of disease in a short period or with pleural effusion. 5. Critical cases (require ICU care)   a. Respiratory failure requiring mechanical ventilation   b. Shock   c. Combined with other organs failure.