COVID-19 among pediatric patients with pre-existing pulmonary conditions: Preliminary results from the Pediatric COVID-19 U.S. Registry

ABSTRACT

Background COVID-19 is a respiratory infection caused by SARS-CoV-2. Adults with pre-existing pulmonary conditions have been reported to be at higher risk of severe disease, but less is known about COVID-19 in pediatric patients with pre-existing pulmonary conditions. We sought to characterize the clinical course and outcomes of COVID-19 among pediatric patients with pre-existing pulmonary conditions in a national passive surveillance registry. Method Demographic, clinical and COVID-19 related data were obtained from the Pediatric COVID-19 U.S. Registry, a passive surveillance registry of pediatric patients less than 21 years old diagnosed with COVID-19 at inpatient and outpatient facilities across the United States. Centers (n = 170) voluntarily submitted information ed from medical records at Days 7- and 28-days post COVID-19 diagnosis. Of the 13,248 cases submitted to the registry, 2143 (16.2%) cases submitted both Days 7 and 28 surveys as well as completed survey questions related to pre-existing pulmonary conditions. Immunocompromised cases, cases missing Day 28 surveys and those missing pre-existing pulmonary condition survey data were excluded from this analysis (n=11,105). Clinical characteristics were summarized descriptively, and chi-square tests (α=0.05) were used to compare COVID-19 clinical course and outcomes between those with and without pre-existing pulmonary conditions. Results Among the 2143 cases included, 1438 (67%) reported a pre-existing pulmonary condition. The majority were male (53.6%), white or Caucasian (41.7%) and non-Hispanic (62.5%). Pulmonary conditions reported included asthma/reactive airway disease (92%) followed by bronchopulmonary dysplasia (4%) and tracheostomy dependence (3%). Approximately one quarter (n=378) of patients with pulmonary conditions were hospitalized and 151 (13%) were admitted to the ICU. Ninety-six (6.7%) experienced respiratory failure, 63 (4%) required mechanical ventilation, and 1 (0.06%) death was reported related to COVID-19. Compared to cases with no pre-existing pulmonary conditions, those with pulmonary pre-existing conditions were significantly (p < 0.05) more likely to experience chest pain (11.7% vs 6.8), wheezing (10.3% vs 1.6%), dyspnea (27.3% vs 10.5%), cough (46.8% vs 30%), and fever (47% vs 34.8%). Patients with pre-existing pulmonary condition were also more likely to be hospitalized for COVID-19 (26% vs 14.8%), admitted to intensive care unit (13% vs 6.4%) and to progress to lower respiratory tract infection (4.1% vs 0.6%). These patients were also more likely to receive oxygen (18% vs 8.2%), steroid treatment (Day 0 to 7) (14% vs 7.7%), and IVIG (7% vs 4.6%). Conclusion When compared to those without pre-existing pulmonary conditions, our data suggests children with pre-existing pulmonary conditions and COVID-19 are more likely to present with symptomatic and severe disease. Future prospective research is needed to fully understand the impact of COVID-19 among this at-risk population.