Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America's hardest-hit city

Jarovsky, Daniel; Fongaro, Giuliana de Freitas; Zampol, Renata Mazzotti; Oliveira, Thales Araújo de; Farias, Camila Giuliana Almeida; Silva, Daniella Gregória Bomfim Prado da; Cavalcante, Denis Tadeu Gomes; Nery, Sabrina Bortolin; Moraes, José Cássio de; Oliveira, Francisco Ivanildo de; Almeida, Flávia Jaqueline; Sáfadi, Marco Aurélio Palazzi

doi:10.1016/j.ijregi.2022.12.003

Cited by 6 publications

(9 citation statements)

References 38 publications

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“…However, these studies were limited to secondary public domain data (the Ministry of Health's epidemiological bulletins), had a much lower number of patients, and were restricted to those attending pediatric intensive care units. [14][15][16][17][18][19] Although most clinical and epidemiological characteristics of our patients were similar to those of other MIS-C cohorts, [20][21][22][23][24] our research highlights some marked differences. We described particularly severe cases in which almost three-quarters (73.3%) were admitted to the PICU.…”

Section: Discussionmentioning

confidence: 62%

“…Such a high rate could be overestimated because intravenous immunoglobulin must be administered and monitored at the PICU, as per the treatment protocol in some participant hospitals. 19 When classified using more objective clinical markers, we showed similar and remarkable rates of severe disease: more than one-third required inotropic support, and 1 in every 5 required mechanical ventilation. Cardinal acute cardiovascular manifestations and complications in classic episodes of MIS-C, 25 such as cardiac collapse and shock, were also frequent in our patients.…”

Section: Discussionmentioning

confidence: 67%

“…Our data strengthen the concept that the risk and duration of hospitalization due to SARS-CoV-2 infection and postinfection manifestations are substantially elevated in children with significant preexisting medical conditions. 19,34,35 Finally, compared with developed countries, the administered therapy was generally like that reported in the literature; aspirin was more frequently prescribed in the KD-like phenotype, while severe cases received significantly more glucocorticoids, antibiotics, and anticoagulants. The only exception is tocilizumab, a monoclonal antibody that selectively binds to the interleukin-6 receptor because the lack of public healthcare coverage is justified by its high cost.…”

Section: Discussionmentioning

confidence: 71%

“…16 Similarly, at one of the largest private hospitals in the country, no deaths directly or indirectly related to SARS-CoV-2 infection (including MIS-C) have been documented, even during the emergence and predominance of Omicron lineages. 19 Our study illustrates the heterogeneous access to health in the country. Although almost 40% of our cohort was admitted to private hospitals, no deaths occurred in this group.…”

Section: Discussionmentioning

confidence: 74%

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High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

Almeida,

Jarovsky,

Almeida Farias

et al. 2023

Pediatric Infectious Disease Journal

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Background: Brazil´s case fatality rate (CFR) of pediatric multisystem inflammatory syndrome in children and adolescents (MIS-C) is among the highest worldwide. Despite these concerns, limited hospital-based and comprehensive pediatric data have been published on MIS-C in Brazilian children. Methods: We performed a descriptive analysis of the MIS-C scores in 16 public and private hospitals providing secondary and tertiary care in the metropolitan area of São Paulo, Brazil. Clinical and demographic information were systematically extracted from the electronic medical records of each patient. Logistic regression analysis was performed to identify the combined effects of MIS-C phenotype, disease severity and comorbidity as dependent variables. Results: A total of 101 patients met the MIS-C criteria and were evaluated. The median age was 67 months, 60% were male, 28.7% were black or afrodescendant and 62.3% were admitted to public hospitals. Underlying medical conditions were observed in 16.8% of patients and were associated with a longer duration of hospitalization. A Kawasaki disease-like phenotype was observed in 43.5% of patients, and they demonstrated a trend of lower median age. Children with severe MIS-C were older (median age 91 months vs. 36 months) and had a nonspecific phenotype, more cardiovascular and respiratory involvement and kidney injury; 73.3% required intensive care, 20.8% required mechanical ventilation and 35.6% required inotropic support. Four deaths occurred (CFR = 3.9%), three of which were in healthy participants. Conclusion: We identified a lower median age, particularly among children with Kawasaki disease-like phenotypes, those with a significant need for intensive care, and a high CFR in MIS-C. Our findings confirmed the increased severity of the disease in the selected Brazilian population.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 74%

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High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

Almeida,

Jarovsky,

Almeida Farias

et al. 2023

Pediatric Infectious Disease Journal

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“…Due to the severity of clinical presentation, there has been a strong interest among researchers to identify any associations between various demographic, clinical, and laboratory factors with outcomes in MIS-C. Specifically, obesity has been evaluated in multiple studies, in part due to its known role as a risk factor associated with hospitalization, intensive care unit (ICU) admission, and death in children with acute COVID-19 infection . Associations between obesity and MIS-C outcomes, however, have been found inconsistently across studies to date .…”

Section: Introductionmentioning

confidence: 99%

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Khoury,

Harahsheh,

Raghuveer

et al. 2023

JAMA Netw Open

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ImportanceObesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.ObjectiveTo compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.Design, Setting, and ParticipantsIn this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.Main Outcomes and MeasuresPatient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI &lt;85th percentile), overweight (BMI ≥85th to &lt;95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.ResultsOf 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P &lt; .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.Conclusions and RelevanceIn this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

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Effect of the COVID-19 pandemic on the pediatric infectious disease landscape

Shmueli,

Lendner,

Ben-Shimol

2023

Eur J Pediatr

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Characteristics and clinical outcomes of COVID-19 in children: a hospital-based surveillance study in Latin America's hardest-hit city

Cited by 6 publications

References 38 publications

High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil’s Coronavirus Pandemic

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Effect of the COVID-19 pandemic on the pediatric infectious disease landscape

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