ABSTRACT
INTRODUCTION: The COVID-19 epidemic has overwhelmed hospitals around the world. However, the risk of overwhelming pediatric intensive care units (PICU) during the pandemic has yet to be characterized. We aimed to describe the COVID and MIS-C burden on a quaternary urban PICU throughout the SARS-CoV-2 pandemic. METHOD(S): We performed a retrospective review of all patients admitted to the PICU positive for SARS-CoV-2 or MIS-C from January 2020 through June 2022. We grouped patients in 4 time periods relating to the four major variant waves. Descriptive statistics were utilized to compare patient characteristics and clinical outcomes of SARS-CoV-2 and MIS-C patients. Mann-Whitney U and Chi-Square analyses were used as appropriate. Further analysis described the incidence and burden of SARS-CoV-2 and MIS-C in our PICU. RESULT(S): 294 of 5000 (5.9%) PICU patients were admitted with SARS-CoV-2 (N=223) or MIS-C (N=71) during the pandemic. SARS-CoV-2 patients were more likely male (46%, p=0.002), less likely to require vasoactive support (25% vs 62%, p=< 0.001) and more likely to require positive pressure ventilation (55% vs 27%, p< 0.001). MIS-C patients had lower platelets, sodium, potassium & albumin (all p< 0.001) and higher creatinine, CRP (all p< 0.001) than SARS-CoV-2 patients on admission. The study period was broken down as follows: January 2020-Sept 2020 (P1), October 2020- March 2021 (P2), April 2021- September 2021 (P3), October 2021- June 2022 (P4). During P1, 5.2 % of all PICU admissions were SARS-CoV-2 related, 47.2% were MIS-C. During P2, 5.2% of all admissions were SARSCoV- 2 related, 40% were MIS-C. During P3, 1.8% of all admissions were SARS-CoV-2 related, 16.7% were MIS-C. During P4, 8.7% were SARS-CoV-2 related, 9.6% were MIS-C. MIS-C was less common during P4 (Omicron surge) compared to either P1 or P2 (Alpha & Delta) (p< 0.001). CONCLUSION(S): SARS-CoV-2 imposed a significant burden on our quaternary PICU. MIS-C and SARS-CoV-2 patients have significant differences. MIS-C is less common in more recent variants. Understanding the impact on the pediatric population as it pertains to acute COVID and MIS-C infection are critical to effective planning in order to mitigate the burden on our health system, particularly the PICU.