COVID-19 Clinical Characteristics and Outcomes in Children and Adolescents Hospitalized at the University Hospital of the West Indies, Jamaica in 2020-2021

ABSTRACT

Objectives: Multisystem inflammatory syndrome of children (MISC) carries a high attributable morbidity. We describe children aged <16 years hospitalised with COVID-19 and/or MISC, April 2020 to June 2021. Methods: All were tested for SARS-CoV-2, infectious disease consultations performed, modified CDC criteria for MISC applied, charts reviewed and data analyzed. Results: Among 79 consecutive children with SARS-CoV-2, 41(52%) were hospitalised;with median age 10.5 years;Afro-Caribbean ethnicity 40(98%);males 21(51%);SARS-CoV-2 RT-PCR positivity 26 (63%), IgG/IgM positivity 7(17%), community exposures 8 (20%). MISC-cases 18 (44%) vs. non-MISC 23(56%) had fever (94% vs. 30%;p<0.01), fatigue/lethargy (41% vs. 4%;p=0.004), rhinorrhoea (28% vs. 4%;p=0.035), elevated neutrophils (100% vs. 87%;p=0.024) and ≥4 abnormal inflammatory biomarkers 13 (72%). MISC-cases had >2 organ/systems (100% vs. 35%;p<0.01), including gastrointestinal (72% vs. 17%;p<0.01), haematological/coagulopathic (67% vs. 4%;p<0.01);dermatologic (56% vs. 0%;p<0.01), cardiac (17% vs. 0%;p=0.042) with Kawasaki Syndrome (44% vs. 0%;p<0.01) and pleural effusions (17% vs. 0%;p=0.042). MISC-cases were treated with intravenous immune gammaglobulin (14, 78%), aspirin (12, 68%), steroids (9, 50%) and intensive care with non-invasive ventilation (2, 11%). One (6%) with pre-morbid illness died, the remainder recovered. Conclusion: MISC was treated successfully with intravenous gammaglobulin, steroids and/or aspirin in 94% before cardiopulmonary decompensation, or need for inotropes, vasopressors, or invasive ventilation.