A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral Diseases (INRVD)

Abstract

Background: To date, less is known about the clinical features of COVID-19 pediatric patients admitting to ICUs. Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes between COVID-19 pediatric patients admitting to ICU and non-ICU settings.Methods: This multicenter study involved 15 general and pediatrics hospitals on confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive real-time reverse transcription polymerase chain reaction (RT-PCR) between March 19 and May 31, 2020, during the initial peak of the COVID-19 pandemic in Iran.Results: Overall, 166 patients were included, of which 61 (36.7%) required ICU admission, especially in <5 years old age group. Malignancy and heart diseases were the most frequent underlying condition. There was significant decrease in platelet counts, PH, HCO3 and base excess as well as increases in creatinine, creatine phosphokinase and potassium levels between ICU-admitted and non-ICU patients. Dyspnea was the major symptom for ICU group patients. Acute respiratory distress syndrome (ARDS), shock and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate was substantially higher in the ICU than in non-ICU patients (45.9% vs. 1.9%, respectively; P<0.001).Conclusions: Underlying diseases were the major contributing factors in COVID-19 pediatric patients for the increased ICU admissions and mortality rates. There are few paraclinical parameters for differentiating pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with younger age and underlying medical conditions and define strategies to control and prevent COVID-19 transmission in this population.