Clinical Presentation of Children with COVID-19 admitted to Pediatric Intensive Care Unit: Single Center Experience

Abstract

Background: Coronavirus disease of 2019 (COVID-19) infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) among children is mostly a mild disease yet it may cause life threatening direct histopathological lung injury and indirect immune dysregulation with hyperimmune response that causes multi inflammatory disease. Aim of work: to study the clinical presentation, indication of admission to pediatric intensive care unit (PICU), complications and outcome in children with COVID-19 infection. Material and Methods: Our prospective observational study included children with COVID-19 admitted to PICU of Fayoum University Hospital, Egypt between January and March 2021. Results:The study included 35 children admitted with severe SARS-Cov-2, diagnosed by CT chest and positive antibodies against SARS-CoV-2, of them 20 (57.1%) were males and 15 (42.9%) females. Their mean ± SD age was 9 ± 8 months (range: 1 month to 10 years). The symptoms were heterogeneous; with fever 29 (82.9%) and cough 29 (82.9%) being the most frequent. The indication of admission to PICU was respiratory failure in 29 patients (80%), pediatric multisystem inflammatory syndrome -temporally associated with SARS-CoV-2 (PMIS-TS) in 5 (14.2%); 3 shocked, 2 of them with Kawasaki-like syndrome and 1 patient with liver cell failure (2.9%). The frequencies of lymphopenia and thrombocytopenia were (80% and 29.4%, respectively). Inflammatory markers, D-dimer, and cardiac enzymes were elevated in 28 (80%) patients. Complications included myocarditis in 8 (22.9%) cases and vascular thrombosis in 4 (11.4%). Intravenous immunoglobulin was prescribed exclusively for myocarditis, 31 (88.6%) of the patients received steroids and 19 (54.2%) received anticoagulants. Eight (22.9%) died; 6 with respiratory failure, 1 with liver cell failure and 1 with PMIS-TS and shock. Four (11.4%) patients were discharged with impaired cardiac function following myocarditis. Thrombocytopenia was found in 7 cases (29.4%) and was associated with mortality among the patients studied (p=0.014). Conclusion:Severe COVID-19 in children presented with pulmonary and non-pulmonary affection. It was complicated by serious complications as myocarditis and vascular thrombosis. PMIS-TS clinically manifested as Kawasaki's disease and/or shock syndrome. Thrombocytopenia was a risk factor of mortality in the studied patients.

Role of Serum Copeptin and Ischemia-modified Albumin in Detection of Cardiac Affection in Neonatal Sepsis

“…As regards echocardiographic findings in cases and control; LVESD and LVEDD were lower in septic compared to aseptic neonates, this may be related to hemodynamic alteration and profound hypovolemia due to sepsis, which can induce myocardial depression and dysfunction. This went with the findings of the studies by Abdel Hakeem et (25)(26)(27)(28) .…”