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1.
Crit Care Med ; 50(1): e40-e51, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1584019

ABSTRACT

OBJECTIVES: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN: Retrospective study. SETTING: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , COVID-19/physiopathology , Child, Hospitalized/statistics & numerical data , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/physiopathology , Adolescent , Age Factors , Body Mass Index , COVID-19/mortality , Child , Child, Preschool , Comorbidity , Female , Hospital Mortality/trends , Humans , Infant , Intensive Care Units/statistics & numerical data , Logistic Models , Male , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/mortality
2.
J Pediatr ; 231: 301-302, 2021 04.
Article in English | MEDLINE | ID: covidwho-1382575
3.
Crit Care Med ; 50(1): e40-e51, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1356720

ABSTRACT

OBJECTIVES: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN: Retrospective study. SETTING: Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS: Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS: In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , COVID-19/physiopathology , Child, Hospitalized/statistics & numerical data , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/physiopathology , Adolescent , Age Factors , Body Mass Index , COVID-19/mortality , Child , Child, Preschool , Comorbidity , Female , Hospital Mortality/trends , Humans , Infant , Intensive Care Units/statistics & numerical data , Logistic Models , Male , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/mortality
4.
European Journal of Medical Case Reports ; 5(3):101-104, 2021.
Article in English | ProQuest Central | ID: covidwho-1237057

ABSTRACT

Background: Combined autoimmune neutropenia (AIN) and immune thrombocytopenia (ITP) is a rare disease that can present as extremely low neutrophil count and platelet count, respectively [1]. Case Presentation: We describe the first case, to the authors' knowledge, of the novel SARS CoV-2 infection and combined AIN and ITP in a healthy 27-year-old male. Conclusion: Viruses have been known to trigger autoimmune diseases in people with genetic predisposition. We speculate that the patient's selective IgM deficiency predisposed him to have autoimmune cytopenia, and SARS-COV-2 triggered him to acquire combined AIN and ITP. Our hypothesis is supported by a lack of evidence of malignancy, a normal morphology on the smear, and an immediate response to IVIG infusion with significant improvement in platelet and neutrophilic count.

5.
J Pediatr ; 228: 315-316, 2021 01.
Article in English | MEDLINE | ID: covidwho-1019311
6.
J Pediatr ; 226: 315, 2020 11.
Article in English | MEDLINE | ID: covidwho-957242
7.
J Pediatr ; 226: 55-63.e2, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-765218

ABSTRACT

OBJECTIVES: To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. STUDY DESIGN: Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory syndrome coronavirus 2 infection. RESULTS: Of 70 children admitted to PICUs, median age was 15 (IQR 9, 19) years; 61.4% male; 38.6% Hispanic; 32.9% black; and 74.3% with comorbidities. Fever (72.9%) and cough (71.4%) were the common presenting symptoms. Twelve patients (17%) met severe sepsis criteria; 14 (20%) required vasopressor support; 21 (30%) developed acute respiratory distress syndrome (ARDS); 9 (12.9%) met acute kidney injury criteria; 1 (1.4%) required renal-replacement therapy, and 2 (2.8%) had cardiac arrest. For treatment, 27 (38.6%) patients received hydroxychloroquine; 13 (18.6%) remdesivir; 23 (32.9%) corticosteroids; 3 (4.3%) tocilizumab; and 1 (1.4%) anakinra; no patient was given immunoglobulin or convalescent plasma. Forty-nine (70%) patients required respiratory support: 14 (20.0%) noninvasive mechanical ventilation, 20 (28.6%) invasive mechanical ventilation (IMV), 7 (10%) prone position, 2 (2.8%) inhaled nitric oxide, and 1 (1.4%) extracorporeal membrane oxygenation. Nine (45%) of the 20 patients requiring IMV were extubated by day 14 with median IMV duration of 218 (IQR 79, 310.4) hours. Presence of ARDS was significantly associated with duration of PICU and hospital stay, and lower probability of PICU and hospital discharge at hospital day 14 (P < .05 for all). CONCLUSIONS: Critically ill children with COVID-19 predominantly are adolescents, have comorbidities, and require some form of respiratory support. The presence of ARDS is significantly associated with prolonged PICU and hospital stay.


Subject(s)
COVID-19/diagnosis , Adolescent , Antiviral Agents/therapeutic use , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Combined Modality Therapy , Comorbidity , Critical Care/methods , Critical Illness , Female , Follow-Up Studies , Humans , Infant , Length of Stay/statistics & numerical data , Male , New York City/epidemiology , Respiratory Therapy/methods , Retrospective Studies , Treatment Outcome , Young Adult
8.
J Pediatr ; 224: 24-29, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-659567

ABSTRACT

OBJECTIVE: To assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C). STUDY DESIGN: Children with MIS-C admitted to pediatric intensive care units in New York City between April 23 and May 23, 2020, were included. Demographic and clinical data were collected. RESULTS: Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; and 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction was found in 63% of patients with median ejection fraction of 46.6% (IQR, 39.5-52.8). C-reactive protein, procalcitonin, d-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation in 1 (3%), and intra-aortic balloon pump in 1 (3%). The left ventricular ejection fraction normalized in 95% of those with a depressed ejection fraction. All patients were discharged home with median duration of pediatric intensive care unit stay of 4.7 days (IQR, 4-8 days) and a hospital stay of 7.8 days (IQR, 6.0-10.1 days). One patient (3%) died after withdrawal of care secondary to stroke while on extracorporeal membrane oxygenation. CONCLUSIONS: Critically ill children with coronavirus disease-2019-associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Betacoronavirus , C-Reactive Protein/analysis , COVID-19 , Child , Child, Preschool , Coronavirus Infections/drug therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant , Intensive Care Units, Pediatric , Male , Natriuretic Peptide, Brain/blood , New York City , Pandemics , Procalcitonin/analysis , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome , Ventricular Function, Left , Young Adult
9.
J Pediatr ; 223: 14-19.e2, 2020 08.
Article in English | MEDLINE | ID: covidwho-232734

ABSTRACT

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


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Critical Illness , Hospitalization , Intensive Care Units, Pediatric/statistics & numerical data , Pneumonia, Viral/epidemiology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adolescent , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Asthma/epidemiology , Blood Urea Nitrogen , C-Reactive Protein/analysis , COVID-19 , Child , Child, Preschool , Coronavirus Infections/blood , Coronavirus Infections/drug therapy , Creatinine/blood , Dyspnea/virology , Female , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Male , Natriuretic Peptide, Brain/blood , New York City/epidemiology , Pandemics , Pediatric Obesity/epidemiology , Platelet Count , Pneumonia, Viral/blood , Pneumonia, Viral/drug therapy , Procalcitonin/blood , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Sepsis/epidemiology , Shock, Septic/epidemiology , Tertiary Care Centers , Young Adult
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