Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City

J Pediatr. 2020 Aug;223:14-19.e2. doi: 10.1016/j.jpeds.2020.05.006. Epub 2020 May 11.

Abstract

Objective: To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19).

Study design: Children 1 month to 21 years of age with COVID-19 from a single tertiary care children's hospital between March 15 and April 13, 2020 were included. Demographic and clinical data were collected.

Results: In total, 67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (P = .99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received Remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. Acute respiratory distress syndrome was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer.

Conclusions: We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.

Keywords: COVID-19; SARS CoV-2; children; critical care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Adolescent
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Antiviral Agents / therapeutic use
  • Asthma / epidemiology
  • Betacoronavirus*
  • Blood Urea Nitrogen
  • C-Reactive Protein / analysis
  • COVID-19
  • Child
  • Child, Preschool
  • Coronavirus Infections / blood
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Creatinine / blood
  • Critical Illness*
  • Dyspnea / virology
  • Female
  • Hospitalization*
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Male
  • Natriuretic Peptide, Brain / blood
  • New York City / epidemiology
  • Pandemics
  • Pediatric Obesity / epidemiology
  • Platelet Count
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Procalcitonin / blood
  • Respiration, Artificial / statistics & numerical data
  • Retrospective Studies
  • SARS-CoV-2
  • Sepsis / epidemiology
  • Shock, Septic / epidemiology
  • Tertiary Care Centers
  • Young Adult

Substances

  • Antiviral Agents
  • Procalcitonin
  • Natriuretic Peptide, Brain
  • remdesivir
  • Adenosine Monophosphate
  • C-Reactive Protein
  • Creatinine
  • Alanine