Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study

Gupta, Vidushi; Singh, Amitabh; Ganju, Sheetal; Singh, Raghvendra; Thiruvengadam, Ramachandran; Natchu, Uma Chandra Mouli; Gupta, Nitesh; Kaushik, Deepali; Chanana, Surbhi; Sharma, Dharmendra; Gosain, Mudita; Rao, Suman; Pandey, Narendra Kumar; Gupta, Arvind; Singh, Sandeep; Jhamb, Urmila; AV, Lalitha; Dinakar, Chitra; Pandey, Anil; Gera, Rani; Chellani, Harish; Wadhwa, Nitya; Bhatnagar, Shinjini

doi:10.1016/j.lansea.2023.100203

Cited by 6 publications

(5 citation statements)

References 28 publications

(29 reference statements)

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“…While reports, mostly based on studies from developed nations, suggest a median age of 9 years for MIS‐C, our study, alongside multicentre studies in Asia and Africa, observed a lower median age 34–36 . We hypothesize that exposure to a diverse range of pathogens and antigens through natural infections and vaccination at a younger age in these regions may foster the development of a robust immunological memory.…”

Section: Discussionsupporting

confidence: 45%

“…6 As shown in Table 1, there were a few significant differences in While reports, mostly based on studies from developed nations, suggest a median age of 9 years for MIS-C, our study, alongside multicentre studies in Asia and Africa, observed a lower median age. [34][35][36] We hypothesize that exposure to a diverse range of Elevated CCL2 levels were identified as an independent predictor and potential biomarker for differentiating AES-Viral from AES-Scrub typhus. This aligns with established knowledge that infected astrocytes, macrophages/microglia, and neurons produce elevated CCL2 levels during viral encephalitis and neuro-COVID, contributing to blood-brain barrier disruption and neuroinvasion 15,38,39 Elevated CCL11 levels, linked to diminished hippocampal neurogenesis and cognitive symptoms observed in long COVID ("COVID fog"), 40,41 were observed in children with AES-MIS-C.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic markers of acute encephalitis syndrome and COVID‐associated multisystem inflammatory syndrome in children from Southern India

Damodar,

Dunai,

Prabhu

et al. 2024

Journal of Medical Virology

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Acute encephalitis syndrome (AES) in children poses a significant public health challenge in India. This study aims to explore the utility of host inflammatory mediators and neurofilament (NfL) levels in distinguishing etiologies, assessing disease severity, and predicting outcomes in AES. We assessed 12 mediators in serum (n = 58) and 11 in cerebrospinal fluid (CSF) (n = 42) from 62 children with AES due to scrub typhus, viral etiologies, and COVID‐associated multisystem inflammatory syndrome (MIS‐C) in Southern India. Additionally, NfL levels in serum (n = 20) and CSF (n = 18) were examined. Clinical data, including Glasgow coma scale (GCS) and Liverpool outcome scores, were recorded. Examining serum and CSF markers in the three AES etiology groups revealed notable distinctions, with scrub typhus differing significantly from viral and MIS‐C causes. Viral causes had elevated serum CCL11 and CCL2 compared with scrub typhus, while MIS‐C cases showed higher HGF levels than scrub typhus. However, CSF analysis showed a distinct pattern with the scrub typhus group exhibiting elevated levels of IL‐1RA, IL‐1β, and TNF compared with MIS‐C, and lower CCL2 levels compared with the viral group. Modeling the characteristic features, we identified that age ≥3 years with serum CCL11 < 180 pg/mL effectively distinguished scrub typhus from other AES causes. Elevated serum CCL11, HGF, and IL‐6:IL‐10 ratio were associated with poor outcomes (p = 0.038, 0.005, 0.02). Positive CSF and serum NfL correlation, and negative GCS and serum NfL correlation were observed. Median NfL levels were higher in children with abnormal admission GCS and poor outcomes. Measuring immune mediators and brain injury markers in AES provides valuable diagnostic insights, with the potential to facilitate rapid diagnosis and prognosis. The correlation between CSF and serum NfL, along with distinctive serum cytokine profiles across various etiologies, indicates the adequacy of blood samples alone for assessment and monitoring. The association of elevated levels of CCL11, HGF, and an increased IL‐6:IL‐10 ratio with adverse outcomes suggests promising avenues for therapeutic exploration, warranting further investigation.

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Diagnostic markers of acute encephalitis syndrome and COVID‐associated multisystem inflammatory syndrome in children from Southern India

Damodar,

Dunai,

Prabhu

et al. 2024

Journal of Medical Virology

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“…smoking or air pollution) and the associations between multiple outcomes are assessed. 17 , 18 In the prospective cohort, exposure is assessed at baseline and the researcher follows the subjects in time to study the development of disease or mortality. In a retrospective cohort, the researcher starts the study at the end of the follow-up and retrospectively identifies the subject’s eligibility and composition, and exposures are assessed at baseline.…”

Section: The Foundation: Study Designmentioning

confidence: 99%

Observational studies: practical tips for avoiding common statistical pitfalls

Sterrantino

2024

The Lancet Regional Health - Southeast Asia

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“…14 In the recent literatures, the severe disease ranges from 7% to 65%. 19,23,24 Length of hospital stay (LOS) of covid-…”

Section: Corona Virus Disease 2019 (Covid-19mentioning

confidence: 99%

Clinical Profile and Outcome of Neonates and Children Diagnosed with COVID-19 in Tertiary Level Teaching hospital in Eastern Nepal

Chaudhary,

Sagar Rimal,

Dahal

et al. 2024

Birat J. Health Sci.

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Introduction: COVID-19 is an acute respiratory infection caused by SARS-CoV-2. The disease spread all over the world so rapidly that WHO has declared global health emergency and pandemic on 30 January 2020.Neonates and children are affected less frequently as compared to adults. Impact and outcome of COVID on neonates are unknown and a major public health concern. However, evidence on neonatal covid is still limited. Objetives: To explore the clinical profile and to find outcome of neonates and children with COVID-19. Methodology: This was an observational, descriptive study done in the pediatric department. Sixty-three neonates and children up to the age of 14-year, diagnosed as Covid-19 by RT-PCR and antibody were included. Results: Sixty-three neonates and children were admitted in PICU, NICU and COVID ward in BMCTH. Thirty-five (56%) were male with predominant age group of 10-14 year (20,31.7%). Children mostly presented with fever (48,76.2%), cough (34,54%) and shortness of breath (24,38.1%). Nine (14.3%) newborns developed late onset neonatal Covid-19 with 6 (66.7%) were term and AGA while 3(33.3%) were preterm and LBW. They presented with fever (5,55%), respiratory distress (5,55%), cough (2,22.2%). Jaundice (22.2%) and cyanosis (11.1%). Respiratory (42,66.7%), gastrointestinal (28,44.5%) and neuromuscular (13, 20.6%) were commonly involved system. Mild, moderate and severe categories of disease were 11 (17%) , 34 (54%)and 18(29%) respectively . 60 (95.2%) children survived and three (4.8%) children died. Average LOS was 4.85 days(median;4days). Eight (12.7%)children developed MIS-C. Conclusion: COVID-19 presentation in children ranged from mild to severe disease with low mortality. Fever, cough and difficulty in breathing were common features in children while fever, difficulty in breathing and sepsis in neonates.

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Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study

Cited by 6 publications

References 28 publications

Diagnostic markers of acute encephalitis syndrome and COVID‐associated multisystem inflammatory syndrome in children from Southern India

Diagnostic markers of acute encephalitis syndrome and COVID‐associated multisystem inflammatory syndrome in children from Southern India

Observational studies: practical tips for avoiding common statistical pitfalls

Clinical Profile and Outcome of Neonates and Children Diagnosed with COVID-19 in Tertiary Level Teaching hospital in Eastern Nepal

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