The Clinical Burden of Sars-Cov-2 on a Pediatric Intensive Care Unit through the Pandemic in Ny

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.

Characteristics and risk factors associated with critical illness in pediatric COVID-19

INTRODUCTION: Little is known regarding the course and severity of pediatric COVID-19. We describe critical illness in pediatric patients with PCR+ SARS-CoV2 infection and identify factors associated with PICU admission and organ dysfunction. METHODS: This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR+ SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. RESULTS: Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n=68) survived to discharge, 1.3% (n=1) remain admitted, and one (1.3%) died. Of PICU patients, 46.7% experienced significant organ dysfunction (pSOFA>=2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p=0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p=0.23) or organ dysfunction (p=0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p=0.005) and presence of organ dysfunction (p=0.001). Initial WBC was associated with organ dysfunction (p=0.034). Presenting thrombocytopenia was associated with organ dysfunction (p=0.003). Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome (6.7%), and cardiac dysfunction (6.7%). CONCLUSIONS: Need for PICU admission in COVID-19 was associated with age over 12 years and elevated initial CRP. Organ dysfunction was associated with elevated admission CRP and WBC and decreased platelet count. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

Reduction in pediatric respiratory admissions during an economic shutdown due to COVID-19

INTRODUCTION: The rapid spread of the SARS-CoV-2 virus and COVID-19 in 2020 has led to shutdowns in many parts of the world. This study was conducted to determine the burden of potentially preventable pediatric respiratory disease by analyzing the changes in respiratory admissions during a period of complete shutdown. METHODS: This was a single-center retrospective observational study at a pediatric tertiary care center located in Queens, New York. Admission data was collected from March 23rd to June 7th for the years 2016-2020 in order to perform a year-over-year analysis of admissions. The study window corresponds to the ?New York State on PAUSE? executive order, during which time all non-essential businesses were closed in the state because the region was an active epicenter for the virus. Admissions were categorized based on the ICD-10 code group corresponding to the admission diagnosis. Patients were only included if they first presented to the emergency department, pediatric ward, or the pediatric ICU. Patients who first presented to the operating room or NICU/newborn nursery were excluded. Comparisons were performed using the chi squared test. RESULTS: From 2016 to 2019, the total number of admissions during the study window ranged between 1880- 1955. In 2020, this number decreased to 1046 admissions, representing a decline of 44.4-46.5% in total admissions. The proportion of total admissions attributed to a respiratory diagnosis ranged between 17.8-19.0% from 2016-2019, and declined to 4.4% for 2020 (p<0.001 vs each year from 2016-2019). The results were similar when 138 COVID-19 associated admissions were removed. PICU admissions decreased from a range of 356-428 admissions from 2016- 2019 to 204 admissions in 2020, representing a decline of 42.7-52.3%. The proportion of PICU admissions attributed to respiratory causes declined from a range of 39.2-40.7% down to 12.3% (p<0.001 vs each year). CONCLUSIONS: The economic shutdown in New York was directly correlated to a significant decrease in the volume of admissions to this pediatric institution, even after excluding operative procedures to control for the cancellation of elective surgeries. A large driver of this decrease in volume is attributed to the reduction in respiratory admissions, likely due to social distancing policies and practices.