Background
Perhaps reflecting that children with COVID-19 rarely exhibit severe respiratory symptoms and often remain asymptomatic, little attention has been paid to explore the immune response in pediatric COVID-19. Here, we analyzed the phenotype and function of circulating neutrophils from children with COVID-19.
Methods
An observational study including 182 children with COVID-19, 21 children with multisystem inflammatory syndrome (MIS-C), and 40 healthy children was performed in Buenos Aires, Argentina. Neutrophil phenotype was analyzed by flow cytometry in blood samples. Cytokine production, plasma levels of IgG antibodies directed to the spike protein of SARS-CoV-2 and citrullinated histone H3 were measured by ELISA. Cell-free DNA was quantified by fluorometry.
Findings
Compared with healthy controls, neutrophils from children with COVID-19 showed a lower expression of CD11b, CD66b, and
L
-selectin but a higher expression of the activation markers HLA-DR, CD64 and PECAM-1 and the inhibitory receptors LAIR-1 and PD-L1. No differences in the production of cytokines and NETs were observed. Interestingly, the expression of CD64 in neutrophils and the serum concentration of IgG antibodies directed to the spike protein of SARS-CoV-2 distinguished asymptomatic from mild and moderate COVID-19.
Interpretation
Acute lung injury is a prominent feature of severe COVID-19 in adults. A low expression of adhesion molecules together with a high expression of inhibitory receptors in neutrophils from children with COVID-19 might prevent tissue infiltration by neutrophils preserving lung function.
Funding
This study was supported by the Ministry of Science and Technology (National Agency for Scientific and Technological Promotion, IP-COVID-19-0277 and PMO BID PICT 2018-2548), and University of Buenos Aires from Argentina (20020170100573BA).
Objectives:
To determine the prevalence of children with complex chronic conditions in PICUs in Argentina. To describe the demographic profile, clinical course and outcomes in PICU of children with complex chronic condition in comparison to previously healthy children.
Design:
Prospective, observational multicenter study.
Setting:
Nineteen PICUs located in Argentina belonging to public and private institutions.
Patients:
All children admitted to the participating PICUs between March 1, 2015, and February 28, 2016.
Interventions:
None.
Measurement and Main Results:
We analyzed 3,483 PICU admissions. The prevalence of complex chronic condition was 48.06% (95% CI, 46.39–49.72). Cardiovascular complex chronic condition was predominant (22.24% [421/1,893]), followed by neuromuscular complex chronic condition (18.75% [355/1,893]) and malignant disease 17.7% (335/1,893). Technologic dependence was present in 22.22% of the patients (372 of 1,674). Predominant admission diagnosis was postoperative (36.6%) and respiratory disease (28.32%). Children with complex chronic condition had higher mortality than previously healthy patients (odds ratio, 2.74; 95% CI, 2.01–3.73). The risk of prolonged stay (≥ 26 d) was also higher (odds ratio, 1.44; 95% CI, 1.10–1.89). Rate utilization of the following devices was higher in patients with complex chronic condition: mechanical ventilation (odds ratio, 1.35; 95% CI, 1.12–1.63), central venous catheter (odds ratio, 1.24; 95% CI, 1.04–1.48), and arterial monitoring (odds ratio, 1.33; 95% CI, 1.09–1.63).
Conclusions:
We observed a high prevalence of patients with complex chronic condition in this sample of argentine PICUs. These patients presented higher mortality and resource use than previously healthy children. This information is valuable to understand the impact that patients with complex chronic condition have on PICU performance and enables proper planning of care.
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