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Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.
Derespina, Kim R; Kaushik, Shubhi; Plichta, Anna; Conway, Edward E; Bercow, Asher; Choi, Jaeun; Eisenberg, Ruth; Gillen, Jennifer; Sen, Anita I; Hennigan, Claire M; Zerihun, Lillian M; Doymaz, Sule; Keenaghan, Michael A; Jarrin, Stephanie; Oulds, Franscene; Gupta, Manoj; Pierre, Louisdon; Grageda, Melissa; Ushay, H Michael; Nadkarni, Vinay M; Agus, Michael S D; Medar, Shivanand S.
  • Derespina KR; Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
  • Kaushik S; Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.
  • Plichta A; Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
  • Conway EE; Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.
  • Bercow A; Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.
  • Choi J; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
  • Eisenberg R; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
  • Gillen J; Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.
  • Sen AI; Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York, NY.
  • Hennigan CM; Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
  • Zerihun LM; Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
  • Doymaz S; Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.
  • Keenaghan MA; Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, St George's University, Grenada, WI.
  • Jarrin S; Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, State University of New York Downstate, Brooklyn, NY.
  • Oulds F; Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.
  • Gupta M; Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
  • Pierre L; Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, NY.
  • Grageda M; Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island, NY.
  • Ushay HM; Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
  • Nadkarni VM; Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Agus MSD; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.
  • Medar SS; Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY. Electronic address: smedar@montefiore.org.
J Pediatr ; 226: 55-63.e2, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-765218
ABSTRACT

OBJECTIVES:

To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. STUDY

DESIGN:

Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory syndrome coronavirus 2 infection.

RESULTS:

Of 70 children admitted to PICUs, median age was 15 (IQR 9, 19) years; 61.4% male; 38.6% Hispanic; 32.9% black; and 74.3% with comorbidities. Fever (72.9%) and cough (71.4%) were the common presenting symptoms. Twelve patients (17%) met severe sepsis criteria; 14 (20%) required vasopressor support; 21 (30%) developed acute respiratory distress syndrome (ARDS); 9 (12.9%) met acute kidney injury criteria; 1 (1.4%) required renal-replacement therapy, and 2 (2.8%) had cardiac arrest. For treatment, 27 (38.6%) patients received hydroxychloroquine; 13 (18.6%) remdesivir; 23 (32.9%) corticosteroids; 3 (4.3%) tocilizumab; and 1 (1.4%) anakinra; no patient was given immunoglobulin or convalescent plasma. Forty-nine (70%) patients required respiratory support 14 (20.0%) noninvasive mechanical ventilation, 20 (28.6%) invasive mechanical ventilation (IMV), 7 (10%) prone position, 2 (2.8%) inhaled nitric oxide, and 1 (1.4%) extracorporeal membrane oxygenation. Nine (45%) of the 20 patients requiring IMV were extubated by day 14 with median IMV duration of 218 (IQR 79, 310.4) hours. Presence of ARDS was significantly associated with duration of PICU and hospital stay, and lower probability of PICU and hospital discharge at hospital day 14 (P < .05 for all).

CONCLUSIONS:

Critically ill children with COVID-19 predominantly are adolescents, have comorbidities, and require some form of respiratory support. The presence of ARDS is significantly associated with prolonged PICU and hospital stay.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Young adult Country/Region as subject: North America Language: English Journal: J Pediatr Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male / Young adult Country/Region as subject: North America Language: English Journal: J Pediatr Year: 2020 Document Type: Article