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Paediatric critical COVID-19 and mortality in a multinational prospective cohort.
Gonzalez-Dambrauskas, Sebastian; Vasquez-Hoyos, Pablo; Camporesi, Anna; Cantillano, Edwin Mauricio; Dallefeld, Samantha; Dominguez-Rojas, Jesus; Francoeur, Conall; Gurbanov, Anar; Mazzillo-Vega, Liliana; Shein, Steven L; Yock-Corrales, Adriana; Karsies, Todd.
  • Gonzalez-Dambrauskas S; Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay.
  • Vasquez-Hoyos P; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia.
  • Camporesi A; Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy.
  • Cantillano EM; UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras.
  • Dallefeld S; Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA.
  • Dominguez-Rojas J; Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú.
  • Francoeur C; Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada.
  • Gurbanov A; Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
  • Mazzillo-Vega L; Pediatric Critical Care Medicine, Hospital infantil Los Ángeles, Pasto, Colombia.
  • Shein SL; Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
  • Yock-Corrales A; Emergency Department. Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS. San José, Costa Rica.
  • Karsies T; Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA.
Lancet Reg Health Am ; 12: 100272, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1945923
ABSTRACT

Background:

To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.

Methods:

Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression.

Findings:

557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old.

Interpretation:

We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19.

Funding:

None.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Lancet Reg Health Am Year: 2022 Document Type: Article Affiliation country: J.lana.2022.100272

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Journal: Lancet Reg Health Am Year: 2022 Document Type: Article Affiliation country: J.lana.2022.100272