What are the risk factors for admission to the pediatric intensive unit among pediatric patients with COVID-19?

Abstract

Background Although with exceptions, evidence seems to indicate that children have lower susceptibility than adults to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. When infected, children generally remain asymptomatic or develop mild disease. A small number of pediatric cases required admission to the pediatric intensive care unit (PICU), respiratory support with a mechanical ventilation and additional life-saving interventions. Even if rarely, death can occur. Aim of this manuscript is to highlight the risk factors associated with severe outcome among pediatric patients with COVID-19. Main findings Early identification of SARS-CoV-2-infected children at risk of developing severe COVID-19 is vital for service planning, as severely affected pediatric patients require high-quality care and should be followed only where an adequately structured PICU is available. However, early identification of children who must be carefully monitored for substantial risk of severe COVID-19 remains difficult. An underlying comorbidity and heart involvement are frequently observed in severe paediatric cases. Reduced left ventricular systolic function with an ejection fraction < 60%; diastolic dysfunction; and arrhythmias, including ST segment changes, QTc prolongation, and premature atrial or ventricular beat, are the earliest manifestations of heart involvement. Inclusion of heart enzyme serum levels and evaluation of ventricular function among predictive markers could lead to a more effective evaluation of children at risk with proper selection of those to admit to the PICU and with more adequate treatment in case of more severe clinical manifestations. Conclusions To appropriately manage severe pediatric COVID-19 cases, greater attention should be paid to risk factors in children and adolescents, especially to cardiovascular alterations (e.g., heart enzyme serum levels and evaluation of ventricular function). Further studies are needed and the development of a validated score based on all the most common presumed markers of disease severity seems essential.

Are we sure that the neurological impact of COVID 19 in childhood has not been underestimated?

“…Most of the symptomatic children had only minor respiratory or gastrointestinal problems. Moreover, the risk of hospitalization and the need for intensive care unit (ICU) admission was found very low and death was an exceptional event [ 4 , 5 ]. These findings explain why pediatric COVID-19 was initially considered a minor clinical problem.…”

A Case Report for Severe COVID-19 in a 9-Year-Old Child Treated with Remdesivir and Dexamethasone

“…Data to clearly establish the risk factors for severe COVID-19 in children are limited. 6 7 9 10 18 19 In a European cohort study, the significant risk factors for ICU admission were age younger than one month, male gender, pre-existing medical conditions, and the presence of lower respiratory tract infection signs or symptoms at presentation. 4 In a study of children with COVID-19 admitted to North American PICUs, most had underlying conditions, with obesity, chronic lung disease, and prematurity the most prevalent.…”

“…2 3 4 5 However, some children and adolescents have had severe experiences with COVID-19, and a few have died. 3 6 7 8 9 10 As of May 6, 2021, over 3.85 million children have tested positive for COVID-19 in the United States, representing 14% of all cases. In state-level reports, children accounted for 0.00–0.21% of all COVID-19 deaths.…”

Manifesto of the pediatricians of Emilia-Romagna region, Italy, in favor of vaccination against COVID in children 5–11 years old

“…The vaccine does not depress the child's ability to respond to infections but, on the contrary, allows the immune system to work "safely" by producing defense weapons in case of exposure to the virus [ 5 ]. Although SARS-CoV-2 infection is certainly more benign in children, in some cases it can cause a serious pathology such as multisystem inflammatory syndrome (MIS-C), which may also require hospitalization in intensive care [ 6 , 7 ]. The long COVID, which consists in the persistence of pathological symptoms such as fatigue, difficulty concentrating, malaise 3 months after even mild SARS-CoV-2 infection, is a growing reality even in pediatric age and it can impact the child's overall physical and especially psychological well-being [ 8 – 11 ].…”