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

• Published in: The Journal of pediatrics Vol. 223; pp. 14 - 19.e2
• Main Authors: Chao, Jerry Y., Derespina, Kim R., Herold, Betsy C., Goldman, David L., Aldrich, Margaret, Weingarten, Jacqueline, Ushay, Henry M., Cabana, Michael D., Medar, Shivanand S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2020
• Subjects: 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; Child; Child, Preschool; children; Coronavirus Infections - blood; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; COVID-19; Creatinine - blood; critical care; 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; Original; 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; New York City; COVID-19; SARS-CoV-2; children; critical care; SARS CoV-2; ICU; ARDS; PICU; ED
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.05.006

To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19). 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. 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. We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.