Eighteen (38%) of 48 COVID-19 patients younger than 17 years hospitalized in 14 pediatric intensive care units (PICUs) in the United States from Mar 14 to Apr 3 required mechanical ventilation, but all but 2 survived, according to a multicenter, cross-sectional study published today in JAMA Pediatrics.
Thirty-three patients (69%) were seriously or critically ill, and 12 (25%) needed drugs to regulate their blood pressure. Thirty-nine patients (81%) required respiratory support, and 21 (44%) received noninvasive ventilation. Six patients (13%) needed additional modes of ventilation or life support.
Forty patients (83%) had significant underlying diseases, half with 1 comorbidity, 8 (17%) with 2 comorbidities, and 9 (19%) with at least 3 comorbidities. The patients ranged in age from 4 to 16 years, with a median age of 13.
Nineteen patients (40%) had complex medical conditions with chronic dependence on technological support, such as tracheostomy associated with development delays or congenital abnormalities, while 11 (23%) had immune suppression or cancer, 7 (15%) were obese, 4 (8%) had diabetes, 3 each (6%) had seizures or congenital heart disease, and 2 each (4%) had sickle cell disease, chronic lung disease, or other congenital malformations.
Two who died had underlying conditions
Thirty-five patients (73%) had respiratory symptoms, while 11 (23%) had failure of at least two organ systems, and 1 patient was asymptomatic. Targeted therapies were used in 28 patients (61%), most often hydroxychloroquine alone (11 patients) or combined with other drugs (10 patients). The authors noted that, since then, the Infectious Diseases Society of America has recommended using hydroxychloroquine for COVID-19 only in clinical trials.
As of Apr 10, 2 patients (4.2%) had died, and 15 (31%) remained hospitalized, with 5 (10%) in critical condition, 3 (6%) still needing mechanical ventilation and 1 (2%) requiring life support. The patients who died were 12 and 17 years old, had underlying diseases, and developed multi-organ failure; 1 had sepsis.
Median age was 13 years, and 8 (17%) were younger than 1 year. Twenty-five patients (52%) were male. Median length of PICU stay for those released from the hospital was 5 days (range, 3 to 9 days), and median length of hospital stay was 7 days (range, 4 to 13 days).
Of the 46 North American pediatric hospitals participating in the study, only 14 reported admitting COVID-19 patients to the PICU, all of them in the United States.
Overall low COVID-19 burden in kids
"We can be cautiously encouraged by the hospital outcomes for patients in this series, with an overall ICU mortality at the end of our follow-up period of less than 5% compared with published mortalities of 50% to 62% in adults admitted to the ICU," the authors wrote.
They also said that the COVID-19 burden in children is low compared with that of seasonal flu, with the US Centers for Disease Control and Prevention reporting 8 deaths in children 14 years or younger from COVID-19 and 169 flu-related deaths in that age-group during the 2019-20 season.
"Thus, up to this time of the pandemic in North America, children continue to face a far greater risk of critical illness from influenza than from COVID-19, pointing to the imperative for ongoing preventive pediatric health maintenance during this time," the authors said.
They noted that, given increasing transmission of the virus across North America, extending sampling going forward will likely identify a higher prevalence of hospitalization in children with COVID-19.