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It's a pleasure to work so productively with authors to help bring their findings to the public. Best wishes for your future studies.
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Thank you for taking the comments and suggestions so carefully into account. Your changes have greatly improved the article. It was a great pleasure to review this interesting paper once again.
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I am satisfied with the corrections made by the authors
I suggest you make sure that your manuscript is re-read and revised by a native English speaker or an equivalent service, as both reviewers have justly highlighted the document's problems in this sense. The suggested modifications are within reach by text modifications alone. However, please take into account the request to provide an evaluation over time if at all possible, given the length the review process has imposed. There is a glut of COVID-19 papers related to similar themes and it would make your work more of a unique contribution to the literature on the subject.
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[# PeerJ Staff Note: The Academic Editor has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at copyediting@peerj.com for pricing (be sure to provide your manuscript number and title) #]
The English language should be improved. Here are some examples:
- line 130 „atleat“ – at least
- Line 174-176 „april“ –April, „may“ May, etc.
- line 260 – „discharges“ discharged
- line 271-272 „the disease was less frequent children“ ... among (?) children...
- line 273 „SARS-CoV-2 infection was confirmed2.18% of the pediatric patients..“
- line 346 „leukocites“ – leukocytes
- line 437-438 „a delayed diagnosis and management might lead to the disease can progression..". etc.
I suggest you have a colleague who is proficient in English and familiar with the subject matter review your manuscript.
Spaces are missing in multiple places. For example:
- line 125 „infectionand“
- line 126 „casein“
- line 130 „atleat“
- line 138 „onNational“
- line 158 „analysisof .... wasperformed“ , etc.
Some areas of Materials and Methods need more details:
line 144-151 Have you created the categories by severity yourself? Please explain why If they are published elsewhere, please provide the reference.
line 160 What nonparametric tests were applied?
line 29 - perhaps a mistake “October 21” -- > October 31
Line 177-181 I suggest there is no need to repeat the same data, what is in the table.
In addition, the data do not match: line 177 “Median age was 6.6 year”; Table 1 “(median 6.35)”
Table 1. Age distribution. The numbers do not match, for example:
0-1 years: total – 34 (26 with symptoms + 3 without symptoms = 29, so 5 children are missed),
1-4 years: total – 40 (32 with symptoms, 10 without symptoms = 42, but not 40..), etc.
Line 192-193: “Among the 47 patients with identified source, 5 patients didn't have any symptoms compatible with SARS-CoV-2 infection.” In Table 1 – 6 patients were without symptoms. Which data is correct?
Line 208-209 I would recommend to provide neurological symptoms more accurately: how many had hypotonia? How many had febrile seizures? Etc.
Line 212-213 I suggest that very different compared group size should be noted as the limitation.
Line 216-219 It would be interesting to know, which symptoms most commonly occurred together. In addition, could you compare with clusters of clinical phenotypes published by Swann OV et al. (http://dx.doi.org/10.1136/bmj.m3249)?
Line 283 “…pediatric cases have risen from 2% of cumulative reported cases in April to 10.5%..” It is not clear when was 10.5% reached. Could you add the details?
Line 292-293 It’s a really interesting observation. Maybe you could speculate, that there are more cases in older children but parents with younger children seek medical help more often.
Line 332 and Table 2. Please define fever, pyrexia, digestive symptoms, neurological symptoms.
The conclusions should be more clear and should be limited to those supported by the results.
Thanks to the authors for the opportunity to review this interesting paper. it is written quite clearly although there are some scattered grammatical errors. Literature references are numerous and appropriate even if some parts need to be expanded.
- Line 68: we well know that children with acute SARS-CoV-2 infection have a milder course of disease than adult do. However, I think it is important to mention here the existence of MIS-C as a possible evolution of the infection that had a significant impact on pediatric population, with corresponding references.
- Line 317: when you discuss about children with underlying conditions, you should add among the references some papers that have analyzed COVID-19 patients with underlying diseases more extensively. For example 1) Tsankov BK et al. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. Int J Infect Dis. 2021 Feb;103:246-256 and 2) Brisca G, et al. Clinical course of COVID-19 in children with pre-existing medical conditions. Acta Paediatr. 2021 Apr;110(4):1291-1292.
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I believe that a significant limitation of the work, as acknowledged by the authors, is the lack of evaluation in the short and especially long term. This implies a scarce possibility of highlighting important data such as hospital returns or even the fraction of children who have subsequently developed a MIS-C. Do you have these information?
in conclusion it is an interesting work which describes the characteristics of pediatric patients with sars-cov-2 infection in a tertiary Romanian hospital. I believe that some minor revisions are needed.
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