Echocardiogram Findings in Pediatric Covid-19 Patients: A 30-Month Experience

ABSTRACT

INTRODUCTION: Since the beginning of COVID-19 pandemic in early 2020, we continue to gather more data on various aspects of COVID-19. While many pediatric studies have concentrated on cardio-vascular effects of Multisystem Inflammatory Syndrome of Childhood (MIS-C), very few studies have evaluated the effect on cardiac physiology during the COVID-19 infection. METHOD(S) It is retrospective chart analysis of patients admitted to Pediatric ICU in a tertiary care center of a children's hospital in South Alabama between January 2020 and June 2022. Patients were identified based on International Classification of Disease (ICD-10) code for COVID-19 (U07.1). During the admission the first echocardiogram (Echo) obtained was evaluated. Patients who did not receive the echocardiogram were excluded. Echo findings were read by board certified pediatric cardiologists. The data was analyzed using SPSS software (V25.0) RESULTS: Among 203 children who were hospitalized with COVID-19 infection, 56 (27.5%) patients had an echocardiogram done during the admission. Those who had echocardiogram done were older than those who did not, with Median age [Inter-Quartile Range (IQR)] of 9.83 (2.45 - 14.08) years vs 4.16 (0.68 - 11.7) years, p = 0.003. Patients who had an Echo had a higher median Length of Stay (LOS) 7.03 (4.85 - 11.78) days vs 3.89 (2.20 - 6.03) days, p< 0.001. Race, ethnicity and gender, were not associated with probability of obtaining Echo, adjusted odds ratio (AOR) [95% CI];0.84 (0.21-3.83), p=0.81;1.2 (0.23- 6.28), p = 0.83;1.31 (0.69-2.45), p =0.4, respectively. Median LV ejection fraction (LVEF) and Tricuspid Valve Regurgitation maximum velocity (TR Vmax) were 68 (62-73) % and 1.81 (0 - 2.27) m/s, respectively. The LOS had a positive correlation with TR Vmax but not with LVEF, coefficient of correlation(R) being 0.33, p = 0.01, and 0.49, p = 0.72, respectively. CONCLUSION(S) Echocardiogram on admission in COVID-19 pediatric patients is more likely to be obtained in older children and is associated with longer length of stay. Also, higher the TR Vmax on the initial Echo, longer is the length of stay of these patients. Although further studies including multi-center trials are needed to get better understanding of findings of Echo is COVID-19 pediatric patients and their role in predicting severity of illness.