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Severe COVID-19 often affects children with co-morbidities




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A preliminary study of COVID-19 in the North American Pediatric ICU (PICU) appears that pediatric patients with significant comorbidities are at increased risk of severe COVID-19 disease.

“Consistent with some other earlier reports of COVID-19 in children, our study found that children with less severe COVID-19 clinical course were much more severe than those reported in adults. But I found that the outcome of the hospital was good. ” Lara S. Shekerdemian, MD, Co-author of the Texas Children’s Hospital in Houston. This study JAMA Pediatrics..

To identify the impact of COVID-19 on North American children in the early stages of this global pandemic, researchers identified 48 COVID-19-positive children who participated in 46 PICUs on March 14th. Multi-institutional cross-sectional research has started. April 3. A total of 52% (n = 25) children were male with a median age of 13 years. 17% (8) of children are younger than 1 year, 13% (6) are 1-5 years old, 15% (7) are 6-10 years old, and 56% (27) are 11-21 years old. Thirty of 46 hospitals did not have severe children with confirmed COVID-19 infection during the study period. This includes all 6 hospitals in Canada.

There were many significant preexisting comorbidities in this cohort, with 50% (n = 24) at 1, 17% (n = 8) at 2, and 19% (n = 9) at 3 or higher. Forty percent of children had medically complex comorbidities. Other comorbidities include immunosuppression / malignant tumors, obesity, Diabetes, seizures, Congenital heart disease, Sickle cell disease, And chronic lung disease.

A total of 69% (n = 33) of patients are severe or severe at admission, 25% (n = 12) require vasoactive agents, and 23% (n = 11) have more than one organ system There was a failure.

In terms of treatment, 61% (n = 28) of patients received targeted therapy. Most frequently used Hydroxychloroquine 21 patients – 11 only, 10 Azithromycin In 7 Rem decivil In 1 Tocilizumab In 1, Azithromycin And Tocilizumab Azithromycin was used in only one patient. Rendescivir was used as a single agent in 2 patients and in combination in 6 patients.

Twenty-one of 39 (54%) were managed non-invasively, while 81% (n = 39) of patients required respiratory support above baseline. The other 18 (38%) children were endotracheal or Tracheostomy Ventilation and supplemental ventilation interventions or extracorporeal therapy were required in 6 children (13%).

At the time the study was published, 2 of the 18 children who needed ventilation had died. Still need 3 Mechanical ventilation, 7 discontinued mechanical ventilation but remained hospitalized, and 6 were discharged. The two patients who died were 12 and 17 years old. The authors said, “Both had preexisting comorbidities, developed multiple organ failure, and one was Gram-negative. Sepsis Before developing COVID-19. “

In total, 15 patients (31%) remained hospitalized and 5 were still at risk. One child was still undergoing extracorporeal membrane oxygenation. Median length of stay at both PICU and hospital was 5 (3-9) and 7 (4-13) days, respectively.

“This study confirms the allegations that children tend to have better outcomes than adults during hospital stay,” said Dr. Lenore Jarvis, a pediatric ED doctor who is a member of the Pediatrics News Editorial Advisory Board. Said. “The mortality rate in their case is certainly lower, and children seem to have less or less severe complications than adults. However, as a disclaimer, children are still sick. Working and is hospitalized. Number of COVID-19 patients (such as within PICU). No immunity. ”Dr. Jarvis was not involved in the study.

The authors acknowledged the limitations of their study, including the limited availability of effective trials of COVID-19 during the study, leading to the possibility that severely ill children would not be tested for a variety of reasons. In addition, although they appeared to be recovering most of the 15 children still in hospital, a follow-up period of only 7 days “ did not rule out possible worse outcomes in this cohort. “.

Dr. Shekeldemian and colleagues also said, “Our presentation here of the treatments offered to this series of severely ill children in COVID-19 is purely descriptive. It does not imply any potential benefit from the law. ”

One doctor reported that he received a grant from the Department of Health and Resource Services. No other related financial disclosures have been reported. Dr. Jarvis did not disclose relevant financial information.

Source: Shekerdemian LS et al. JAMA Pediatrics. May 11, 2020. Doi: 10.1001 / jamapediatrics.2020.1948..

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