COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran)

Abstract

Background. The novel coronavirus disease 2019 (COVID-19) started in Wuhan, China, in December 2019. It spread widely around the world and was described as a pandemic by the World Health Organization (WHO). The knowledge regarding the mortality rate and risk factors of COVID-19 among the pediatric population is lacking. In this regard, we aimed to report the clinical and laboratory characteristics of deceased pediatric patients with SARS-CoV-2 infection. Method. This cross-sectional study was conducted in Mofid Children’s Hospital, Tehran, Iran, from February 2020 to April 2021. Recorded documents of 59 pediatric patients (under 18 years old) assumed to have COVID-19 who had died in the COVID-19 ward and COVID-19 intensive care unit (ICU) were retrospectively evaluated. All statistical analyses were performed using SPSS software (v. 26.0, Chicago, IL). A P value of less than 0.05 was considered statistically significant. Results. From 711 COVID-19 definite and suspected patients, 59 children died. Of these deceased pediatric patients, 34 were boys (57.62%) and 25 were girls (42.37%), with a total mean age of 5.6 years. The median length of stay in the hospital was 10 days (range 1–215). 91.52% had underlying comorbidities of which neurological diseases accounted for the largest share. 54 patients were admitted to the ICU and 83.05% of them had intubation during their hospitalization. In addition, the most common reasons for death in our study were related to respiratory and multiorgan failure. Conclusion. According to our knowledge, we are the first team to report such a thorough study in the field of COVID-19 pediatric mortality in Iran. Mortality was observed in all age groups of children, especially in those with previous comorbidities, specifically neurological disease. Abnormally elevated tests of ESR, CRP, LDH, AST, and ALT as well as the presence of proteinuria and hematuria were found in more than 50% of patients in our investigations, and ICU admission between both definite and suspected groups had significant differences, so monitoring and considering these factors may help to control and reduce the progression of the disease to death.

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

“…These differences in ethnic groups may be indicative of wider disparities such as socioeconomic status, cultural differences, or access to healthcare, which are worthy of further study [ 41 ]. Our results are also in line with a recent systematic review up to May 2021, which also found higher odds of severe disease and death in CYP aged >10 years and underlying comorbidities, especially neurological or cardiac conditions [ 42 ], which is consistent with other published studies [ 11 , 15 , 42 , 43 ]. Notably, however, compared to children who died of other causes in England, previous analyses found that underlying health conditions were not overrepresented in children who died of COVID-19 [ 15 , 44 ], or among survivors and non-survivors in children hospitalised for COVID-19 [ 45 ].…”

In-hospital mortality of COVID-19 in Iranian children and youth: A multi-centre retrospective cohort study

“…Moreover, these patients had an increased risk of in-hospital mortality than the other patients. These findings were consistent with the results of the previously conducted studies [ 17 , 18 , 30 , 31 ].…”

“…Pre-existing disorders were observed among 10.2% of the hospitalized children. This finding was consistent with the results of the previous study conducted in Iran [ 17 ]; however, it was much lower than the reported findings by Armin et al [ 18 ]. Comorbidities were a decisive risk factor for ICU admission and COVID-19 mortality.…”

“…COVID-19 mortality in paediatric patients ranged from 0% in Norway to 12% in some reports from Latin America [14][15][16]. The previous studies in Iran reported paediatric COVID-19 mortality at 5.3% [17] and 8.2% [18] which were higher than the reported values from high-income and developed countries [19,20]. The previous studies addressed younger ages, comorbidity, and dyspnoea as the significant risk factors for COVID-19 mortality [17,18,21].…”

The Impact of Alpha Variant (B.1.1.7), Viral Load, and Age on the Clinical Course of Pediatric COVID-19 Patients

“…Age groups were determined based on the World Health Organization Guideline on “COVID-19 disease in children and adolescents.” 12 The clinical severity was determined using the classification system proposed by Dong et al and summarized in Table 1 . 13 14 15 16 17 The medical records of parents and siblings were investigated and the source of infection was determined as a household contact if the SARS-CoV-2 RT-qPCR test of a household contact was positive within 5 days' of the case.…”