Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City

Abstract

Objectives To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. Study design Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory syndrome coronavirus 2 infection. Results Of 70 children admitted to PICUs, median age was 15 (IQR 9, 19) years; 61.4% male; 38.6% Hispanic; 32.9% black; and 74.3% with comorbidities. Fever (72.9%) and cough (71.4%) were the common presenting symptoms. Twelve patients (17%) met severe sepsis criteria; 14 (20%) required vasopressor support; 21 (30%) developed acute respiratory distress syndrome (ARDS); 9 (12.9%) met acute kidney injury criteria; 1 (1.4%) required renal-replacement therapy, and 2 (2.8%) had cardiac arrest. For treatment, 27 (38.6%) patients received hydroxychloroquine; 13 (18.6%) remdesivir; 23 (32.9%) corticosteroids; 3 (4.3%) tocilizumab; and 1 (1.4%) anakinra; no patient was given immunoglobulin or convalescent plasma. Forty-nine (70%) patients required respiratory support: 14 (20.0%) noninvasive mechanical ventilation, 20 (28.6%) invasive mechanical ventilation (IMV), 7 (10%) prone position, 2 (2.8%) inhaled nitric oxide, and 1 (1.4%) extracorporeal membrane oxygenation. Nine (45%) of the 20 patients requiring IMV were extubated by day 14 with median IMV duration of 218 (IQR 79, 310.4) hours. Presence of ARDS was significantly associated with duration of PICU and hospital stay, and lower probability of PICU and hospital discharge at hospital day 14 ( P < .05 for all). Conclusions Critically ill children with COVID-19 predominantly are adolescents, have comorbidities, and require some form of respiratory support. The presence of ARDS is significantly associated with prolonged PICU and hospital stay.

A compromised specific humoral immune response against the SARS-CoV-2 receptor-binding domain is related to viral persistence and periodic shedding in the gastrointestinal tract

“…Third, age is an essential factor that affects the clinical outcomes of SARS-CoV-2 infection. 17,18 Regarding the patient age distribution, no significant difference was observed between the negative retest group (n = 268) and the positive retest group (n = 21) ( Fig. 2c).…”

Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

“…Cases of patients in this study have been published previously at least in part (Appendix; available at www.jpeds.com). 2,3,11,[15][16][17][18][19][20][21][22][23] Cases were identified at each participating site using active, hospital-based surveillance for COVID-19 and MIS-C using standardized inclusion criteria and case definitions. Patients were included if they were hospitalized between March 1, 2020, and May 22, 2020 for any reason, were ≤22 years of age at the time of admission, and ) had a positive diagnostic test for SARS-CoV-2 using reverse-transcriptase polymerase-chain-reaction (PCR) to detect the viral RNA, or met the MIS-C case definition as set by Centers for Disease Control and Prevention (CDC), 24 which includes: age <21 years, reported or documented fever for more than 24 hours, laboratory markers of inflammation, multisystem (≥ 2) organ involvement, positive SARS-CoV- life and pregnant patients were excluded.…”

“…The baseline characteristics of the overall cohort are detailed in The distribution of baseline patient characteristics varied significantly between the different clinical syndromes ( Table 3). Patients with respiratory disease were older than those with MIS-C (median age: 14 [IQR: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] vs. 7 [IQR:3-11] years, respectively, P<.001).…”

Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation

“…In comparison to adults, acute coronavirus disease (COVID-19) appears mild in children, comprising approximately 1% of admissions to hospital [2] , [3] . However, severe acute disease has been described, and is frequently associated with co-morbidities [4] .…”