Vulnerable subpopulations in Caribbean children and adolescents hospitalized with COVID-19

ABSTRACT

Objective: To identify factors associated with the need for supportive hospitalised care among children admitted for COVID-19. Design and Methods: A multicentre retrospective descriptive cohort of children <17 years , hospitalized with COVID- 19 in nine hospitals in Barbados, The Bahamas, and Jamaica from September 2020 to July 2021. The need for supportive therapy was explored by age, and among children with and without a range of comorbidities. Result(s) Among 238 hospitalized children, 56% were < 5 years of age. Comorbidities were present in 107 (45%), with proportionately more comorbidities among older children (> 5 years of age, p < 0.001). Comorbidities included asthma 21(9%), sickle cell disease 20 (8%), neurological 12 (5%) or cardiac 11 (5%) diseases, and diabetes 11 (5%). Multisystem Inflammatory Syndrome (MISC) was present among 32 (13%) children, and of these the largest proportion 12 (29%) were between 5 and 9 years of age (p = 0.04). All diabetic children had diabetic ketoacidosis (DKA), and 83% of neurology cases had seizures. Oxygen use was common among children with asthma (50%), obesity (75%) and MIS-C (40%). Blood products were required among children with MISC (40%), or with malignancy (50%). Almost three-quarters of children with MISC had additional complications, including liver dysfunction, acute kidney injury, and anaemia, and these children regularly required inotropes (22%), non-invasive ventilatory support (12%), or ICU admission (34%). Conclusion(s) Children with asthma, obesity, malignancy, diabetes and neurological disease require additional support with more ICU support needed in MISC cases. Care of vulnerable groups and early recognition and intervention for severe MISC should be prioritized.