The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit

Abstract

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has collapsed health systems worldwide. In adults, the virus causes severe acute respiratory distress syndrome (ARDS), while in children the disease seems to be milder, although a severe multisystem inflammatory syndrome (MIS-C) has been described. The aim was to describe and compare the characteristics of the severe COVID-19 disease in adults and children. Methods This prospective observational cohort study included the young adults and children infected with SARS-CoV-2 between March–June 2020 and admitted to the paediatric intensive care unit. The two populations were analysed and compared focusing on their clinical and analytical characteristics and outcomes. Results Twenty patients were included. There were 16 adults (80%) and 4 children (20%). No mortality was recorded. All the adults were admitted due to ARDS. The median age was 32 years (IQR 23.3–41.5) and the most relevant previous pathology was obesity (n = 7, 43.7%). Thirteen (81.3%) needed mechanical ventilation, with a median PEEP of 13 (IQR 10.5–14.5). Six (37.5%) needed inotropic support due to the sedation. Eight (50%) developed a healthcare-associated infection, the most frequent of which was central line-associated bloodstream infection (n = 7, 71.4%). One patient developed a partial pulmonary thromboembolism, despite him being treated with heparin. All the children were admitted due to MIS-C. Two (50%) required mechanical ventilation. All needed inotropic support, with a median vasoactive-inotropic score of 27.5 (IQR 17.5–30). The difference in the inotropic requirements between the two populations was statistically significant (37.5% vs. 100%, p < 0.001). The biomarker values were higher in children than in adults: mid-regional pro-adrenomedullin 1.72 vs. 0.78 nmol/L (p = 0.017), procalcitonin 5.7 vs. 0.19 ng/mL (p = 0.023), and C-reactive protein 328.2 vs. 146.9 mg/L (p = 0.005). N-terminal pro-B-type natriuretic peptide and troponins were higher in children than in adults (p = 0.034 and p = 0.039, respectively). Conclusions Adults and children had different clinical manifestations. Adults developed severe ARDS requiring increased respiratory support, whereas children presented MIS-C with greater inotropic requirements. Biomarkers could be helpful in identifying susceptible patients, since they might change depending on the clinical features.

Clinical, laboratory and imaging characteristics, and outcomes of hospitalized children with suspected COVID-19 infection

“…Several studies from different countries have been reported their epidemiological findings for COVID-19 in children. [ 11 12 13 14 15 ]…”

Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience

“…Contrary to adults, only an extremely small percentage of children infected by SARS-CoV-2 had severe respiratory symptoms and progression to ARDS [ 5 , 36 ]. There is paucity of data on the occurrence of PARDS in pediatric patients with COVID-19.…”

Diverse Manifestations of COVID-19: Some Suggested Mechanisms

“…Cases of COVID-19 were seven times lower in younger children [ 26 ]. In general, adults were more prone to severe ARDS (acute respiratory distress syndrome), whereas children normally had milder symptoms, although some had multisymptom inflammatory syndrome (MIS-C) [ 60 ]. As with adults, not all children with COVID-19 have the same manifestations.…”

“…Thus, some children may have more or less entry points for the virus than other children, and this may be associated with why some develop the disease. Whether or not children with COVID-19 were obese or had other health issues was not noted [ 60 ].…”