Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City

Abstract

Objective To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19). Study design Children 1 month to 21 years of age with COVID-19 from a single tertiary care children's hospital between March 15 and April 13, 2020 were included. Demographic and clinical data were collected. Results In total, 67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (P = .99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received Remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. Acute respiratory distress syndrome was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer. Conclusions We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.

WITHDRAWN: The Negative Impact of Obesity on the Occurrence and Prognosis of the 2019 Novel Coronavirus (COVID-19) Disease: A Systematic Review and Meta-Analysis

“…and data regarding the secondary outcomes was reported in 43 studies(8, 9, 16-25, 31, 32, 34-38, 42, 43, 45-55, 57-61, 64, 67, 68, 70-72). A study by Chao et al(73) was exclusively performed on children and thus was not included in the meta-analysis. Included publications were all observational in nature, published in 2020.…”

Hematological manifestations of SARS‐CoV‐2 in children

“…[12][13][14]18 Hb levels were normal in asymptomatic children with COVID-19 but also in severe disease, 12,18 and did not differ between children admitted to the ICU or to a medical unit. [12][13][14] Anemia was a common feature in the children with a Kawasaki-like disease associated with SARS-CoV-2 infection, called multisystem inflammatory syndrome. 39 One case report described a 17-year-old male with a history of refractory chronic immune thrombocytopenia that manifested as autoimmune hemolytic anemia during infection with SARS-CoV-2.…”

“…Original studies published up to July 27, 2020 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] providing data on white blood cell (WBC) abnormalities in children with COVID-19 are shown in Table 1.…”

ARDS in an ex‐premature infant with bronchopulmonary dysplasia and COVID‐19

“…2,3 ARDS has been reported in 3% to 17% of all COVID-19 patients and in about 60% of children requiring intensive care. 4 Our patient met the Berlin criteria for severe ARDS with PaO 2 /FiO 2 ratio less than 100. Our patient had worsening hypoxemia and increased inflammatory markers of CRP and procalcitonin, low platelets, and initial acute kidney injury similar to that seen by Chao et al 4 The severe transaminitis noted in our patient has not been reported in the pediatric studies published thus far.…”