ABSTRACT
An 18-year-old girl presenting with respiratory and gastrointestinal symptoms was found to have COVID-19 pneumonia and severe acute respiratory distress syndrome (ARDS). She was transferred to our pediatric intensive care unit (PICU) for ongoing mechanical ventilation and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) for management of progressive hypoxic respiratory failure. She developed a worsening cough with associated life-threatening desaturation events that impaired ECMO flow and required deep sedation. Despite multiple sedative agents, our patient continued to have frequent coughing episodes with associated tachycardia, hypertension, and hypoxemia. The PICU team started nebulized lidocaine 1% 4 mL (40 mg) every 6 hours with albuterol pretreatment, gabapentin, and scheduled ipratropium. Lidocaine levels were <1 mcg/mL throughout the treatment duration. Nebulized lidocaine was stopped after 18 days given improvement in coughing episode severity. Our patient is one of the first reports of an adolescent patient receiving nebulized lidocaine for COVID-19 associated cough. Administration of nebulized lidocaine was well tolerated in this patient without adverse effects and was associated with decreased sedation needs. Given the widespread impact of the COVID-19 pandemic and its sequelae in pediatric, adolescent, and adult patients, additional research is warranted to explore options for management of COVID-19 associated cough.
Subject(s)
COVID-19 , Respiratory Distress Syndrome , Respiratory Insufficiency , Adolescent , Child , Female , Humans , Cough/drug therapy , Cough/etiology , COVID-19/complications , Hypoxia , Lidocaine , PandemicsABSTRACT
This cohort study uses data from the US National COVID Cohort Collaborative to evaluate upper airway infections in children during the surge of the Omicron (B.1.1.529) variant of SARS-CoV-2 in the US.
Subject(s)
COVID-19 , SARS-CoV-2 , Acute Disease , Child , Cohort Studies , Humans , SARS-CoV-2/geneticsABSTRACT
Importance: Understanding of SARS-CoV-2 infection in US children has been limited by the lack of large, multicenter studies with granular data. Objective: To examine the characteristics, changes over time, outcomes, and severity risk factors of children with SARS-CoV-2 within the National COVID Cohort Collaborative (N3C). Design, Setting, and Participants: A prospective cohort study of encounters with end dates before September 24, 2021, was conducted at 56 N3C facilities throughout the US. Participants included children younger than 19 years at initial SARS-CoV-2 testing. Main Outcomes and Measures: Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs multisystem inflammatory syndrome in children (MIS-C), and Delta vs pre-Delta variant differences for children with SARS-CoV-2. Results: A total of 1â¯068â¯410 children were tested for SARS-CoV-2 and 167â¯262 test results (15.6%) were positive (82â¯882 [49.6%] girls; median age, 11.9 [IQR, 6.0-16.1] years). Among the 10â¯245 children (6.1%) who were hospitalized, 1423 (13.9%) met the criteria for severe disease: mechanical ventilation (796 [7.8%]), vasopressor-inotropic support (868 [8.5%]), extracorporeal membrane oxygenation (42 [0.4%]), or death (131 [1.3%]). Male sex (odds ratio [OR], 1.37; 95% CI, 1.21-1.56), Black/African American race (OR, 1.25; 95% CI, 1.06-1.47), obesity (OR, 1.19; 95% CI, 1.01-1.41), and several pediatric complex chronic condition (PCCC) subcategories were associated with higher severity disease. Vital signs and many laboratory test values from the day of admission were predictive of peak disease severity. Variables associated with increased odds for MIS-C vs acute COVID-19 included male sex (OR, 1.59; 95% CI, 1.33-1.90), Black/African American race (OR, 1.44; 95% CI, 1.17-1.77), younger than 12 years (OR, 1.81; 95% CI, 1.51-2.18), obesity (OR, 1.76; 95% CI, 1.40-2.22), and not having a pediatric complex chronic condition (OR, 0.72; 95% CI, 0.65-0.80). The children with MIS-C had a more inflammatory laboratory profile and severe clinical phenotype, with higher rates of invasive ventilation (117 of 707 [16.5%] vs 514 of 8241 [6.2%]; P < .001) and need for vasoactive-inotropic support (191 of 707 [27.0%] vs 426 of 8241 [5.2%]; P < .001) compared with those who had acute COVID-19. Comparing children during the Delta vs pre-Delta eras, there was no significant change in hospitalization rate (1738 [6.0%] vs 8507 [6.2%]; P = .18) and lower odds for severe disease (179 [10.3%] vs 1242 [14.6%]) (decreased by a factor of 0.67; 95% CI, 0.57-0.79; P < .001). Conclusions and Relevance: In this cohort study of US children with SARS-CoV-2, there were observed differences in demographic characteristics, preexisting comorbidities, and initial vital sign and laboratory values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes.
Subject(s)
COVID-19/epidemiology , Adolescent , Age Distribution , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , Child , Child, Preschool , Comorbidity , Disease Progression , Early Diagnosis , Female , Humans , Infant , Male , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sociodemographic Factors , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , United States/epidemiology , Vital SignsABSTRACT
B Introduction: b SARS-CoV-2 can cause severe pediatric disease via acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Outcomes included case incidence and severity over time, risk factors for higher severity disease, vital sign and lab trajectories, clinical outcomes, and acute COVID-19 vs. We sought to determine the characteristics, changes over time, outcomes, and severity risk factors of SARS-CoV-2 infected children within the National COVID Cohort Collaborative (N3C). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
The overwhelming majority of pediatric cases of SARS-CoV-2 infection are mild or asymptomatic with only a handful of pediatric deaths reported. We present a case of severe COVID-19 infection in a pediatric patient with signs of hyperinflammation and consumptive coagulopathy requiring intubation and extracorporeal membrane oxygenation (ECMO) and eventual death due to ECMO complications.