ABSTRACT
This study aimed to assess different clinical, disease severity, laboratory, treatment, and outcome-related factors of COVID-19 positive infants admitted to a pediatric intensive care unit (PICU) and to compare these parameters with COVID-19 positive noninfants (1-12 years of age) who also required intensive care admission. This retrospective observational study was conducted in a PICU of a tertiary care, dedicated pediatric COVID facility. The clinical, epidemiological, laboratory parameters, and treatment outcomes of COVID-19 infected infants admitted to the PICU were recorded and analyzed. During comparison with the noninfant group, malignancy and coinfection with dengue and scrub typhus were excluded from both groups. A total 313 COVID-19 positive children aged from 1 month to 12 years old were admitted, of which 115 (36.7%) children required PICU admission. Infants constituted 37.4% of total PICU admissions. Most common symptoms were respiratory (83.7%) followed by fever (60.5%). Fifteen (34.9%) infants presented with shock. Ten infants (23.3%) had myocardial dysfunction. C-reactive protein (CRP) and ferritin were high in 60.5 and 16.7% infants, respectively. Fourteen infants needed invasive mechanical ventilation. Nine patients had acute respiratory distress syndrome (ARDS) and five had MIS-C. However, 53.5% infants had different comorbidities. Four infants died and all of them had severe comorbidities. Respiratory distress (p = 0.009), pediatric sequential organ failure assessment score (p = 0.032) and number of ARDS cases (p = 0.044) were significantly higher in infants than noninfants. Infants are one of the most vulnerable groups of children suffering from serious illness from COVID-19 infection requiring PICU admission due to predominantly respiratory involvement. Overall outcome was good among infants without significant comorbidity.
ABSTRACT
Evaluation of acquired demyelinating syndrome (ADS) without diagnostic biomarkers results in diagnostic and therapeutic challenges in pediatric population. Immune-mediated ADS of childhood responds well to steroid and intravenous immunoglobulin (IVIg) and in refractory cases with plasma exchange. Novel coronavirus disease 2019 (COVID-19) coinfection in such cases imposes technical challenges in management. An 11-year-old girl with quadriparesis and loss of vision and a magnetic resonance imaging (MRI) brain showing acute demyelinating encephalomyelitis (ADEM) and cerebrospinal fluid examination being noncontributory responded well with plasma exchange after failing steroid and IVIg is described. Coinfection with COVID-19 mandating personal protection in a temperate country imposed technical challenges in her management.