High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru

Abstract

Introduction: Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting.Methods: Prospective case-control study that included patients < 17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality, and secondary outcomes were laboratory results and length of stay. Fisher’s exact test and the Mann-Whitney U test were used for the analysis.Results: Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity.Conclusion: Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients.

Pediatric ARDS phenotypes in critical COVID-19: implications for therapies and outcomes

“…37 Also, there are reports regarding differences in mortality between high and lowmiddle-income countries. 39,40 It is very interesting that in the current study, previous known variables associated with mortality in PARDS and in pediatric critical COVID-19, like organ failures and hypoxemia severity, were not different between survivors and non-survivors. 37,38,[41][42][43][44][45] A surprising result was the difference in the respiratory mechanics between the clinical phenotypes.…”

Cerebrovascular Complications in Pediatric Patients with COVID-19 Infection

“…3 A smaller series of 47 patients with SARS-CoV-2 admitted to the intensive care unit at two sites in Peru demonstrated stroke in 12.8% of patients (6 of 47 patients). 57 Notably, hemorrhagic stroke was more common than ischemic stroke in this cohort. Overall, at least 26 studies have been reported of pediatric patients with stroke related to COVID-19 infection (►Table 2).…”

“…[15][16][17][18]53 Studies demonstrate that many affected patients have at least one preexisting risk factor for stroke. 3,8,57 Mechanical thrombectomy can be successfully used to treat large-vessel occlusion in the setting of SARS-CoV-2. 59 Despite treatment, studies suggest that SARS-CoV-2-related stroke in children results in greater mortality than infection or MIS-C alone.…”

“…59 Despite treatment, studies suggest that SARS-CoV-2-related stroke in children results in greater mortality than infection or MIS-C alone. 3,57 Continued investigations are needed to better understand the role and management implications of infection in the setting of pediatric stroke.…”

“…8 Subsequent investigations attempted to identify the incidence of stroke within various patient populations, often as a subset of pediatric patients with neurological complications of infection. 3,4,7,39,45,57,58 One study of 1,695 pediatric patients hospitalized for COVID-19 or MIS-C across 61 institutions showed an incidence of life-threatening acute ischemic or hemorrhagic stroke of 27.9% (12 of 43 patients with life-threatening neurological disease). 3 A smaller series of 47 patients with SARS-CoV-2 admitted to the intensive care unit at two sites in Peru demonstrated stroke in 12.8% of patients (6 of 47 patients).…”