A Multicenter Study of Covid-19 Infection in Pediatric Intensive Care Units in the Us

ABSTRACT

Background: To describe characteristics of COVID-19 infection among patients requiring admission to pediatric intensive care units (PICU) in the USA. Method(s) Observational surveillance study of COVID-19 infected patients admitted to PICUs in 27 US states between April 1, 2020 - May 1, 2021. Result(s) Four hundred fifty-three patients were included;the majority were from institutions in the South and Midwest regions (40% and 34%). The population was mainly male (57%) and Hispanic (36%), with a median age of 10 years (IQR 4-15). 76% had 1 or more comorbidity. Patient's or caregiver's reported sources for COVID-19 infection were household and community contacts (31% and 24%). One hundred sixty-seven (40%) individuals were diagnosed with the multisystem inflammatory syndrome in children (MISC) within 7 days of PICU admission. Compared to COVID-19 cases without MISC, gastrointestinal, mucocutaneous, and neurological signs and symptoms were more frequent at PICU admission. Nasal cannula (20%) and high-flow oxygen (12.4%) were the most common respiratory support strategies at day 1 of admission, and mechanical ventilation by day 7. Overall, 104 (23%) and 8 (1.8%) individuals were placed on mechanical ventilation and extracorporeal membrane oxygenation (ECMO) within the interval of observation. Steroids and remdesivir were the most delivered COVID-19 targeted therapies (60% and 33%), and only 3% of the patients received convalescent plasma;IVIG (86.8%) and anakinra (61%) were commonly used among individuals with MISC. The overall mortality proportion (MP) was 2.65 (n= 12), and mortality was more frequent among individuals > 2 years old. Of the 167 children with MISC, only 1 died, MP (0.6). Conclusion(s) Mortality associated with pediatric COVID-19 infection is less frequent than in critically ill COVID-19-infected adults. Among pediatric/ adolescent patients, children > 2 years are the most vulnerable to adverse COVID-19-associated outcomes. MISC cases were frequent, yet mortality was low.