To describe the characteristics of hospitalized children with severe acute respiratory syndrome coronavirus 2 in New York City metropolitan area. PATIENTS AND METHODS:This was a multicenter, retrospective cohort study at 4 hospitals comprising 82 hospitalized children (0-21 years) who tested positive for severe acute respiratory syndrome coronavirus 2 after symptoms and risk screening between March 1 and May 10, 2020. We subdivided patients on the basis of their admission to acute or critical care units and by age groups. Further subanalyses were performed between patients requiring respiratory support or no respiratory support. RESULTS: Twenty-three (28%) patients required critical care. Twenty-nine (35%) patients requiring respiratory support, with 9% needing mechanical ventilation, and 1 required extracorporeal support. All patients survived to discharge. Children with any comorbidity were more likely to require critical care (70% vs 37%, P 5 .008), with obesity as the most common risk factor for critical care (63% vs 28%, P 5 .02). Children with asthma were more likely to receive respiratory support (28% vs 8%, P 5 .02), with no difference in need for critical care (P 5 .26). Children admitted to critical care had higher rates of renal dysfunction at presentation (43% vs 10%, P 5 .002). CONCLUSIONS:Children with comorbidities (obesity and asthma in particular) were at increased risk for critical care admission and/or need for respiratory support. Children with renal dysfunction at presentation were more likely to require critical care.

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The COVID-19 pandemic caused by the SARS-CoV-2 virus presents new diagnostic challenges including differentiating COVID-19 infection from other diagnostic entities. Both COVID-19 infection and acute endocarditis may present with hypoxic respiratory failure, fever, and elevated inflammatory biomarkers. The task of distinguishing the two is complicated by the complexities of interpreting SARS-CoV-2 RT-PCR test results. The RT-PCR test may be negative early in the disease course 1-3 and may remain positive long after the initial infection due to viral clearance delay. 4,5 Here, we present two cases of left-sided endocarditis, which were both initially attributed to COVID-19 infection, and only correctly diagnosed after echocardiography was performed.

Twenty-seven pediatric residents were assessed for knowledge, attitudes, and behaviors regarding rights of immigrant families. A program documenting immigrant rights was reinforced in the clinic with posters and individual consultations on immigrant children's needs. This brief program was effective in instructing residents on health and nutritional services for immigrant patients.